In rare cases, people hospitalized for COVID-19 can develop heart failure, even if their hearts were previously healthy, new research shows.
The researchers found that of over 6,400 COVID-19 patients at their hospital, 0.6% newly developed heart failure. That included eight patients — mostly relatively young men — with no history of heart disease or risk factors for it.
Heart failure arises when the heart cannot pump blood effectively enough to meet the body’s needs, which results in symptoms like breathlessness, rapid heart rate, fluid buildup, and swelling in the legs and feet.
Doctors have known that COVID-19 patients can develop heart failure, but it has not been clear how frequently that happens.
“That’s the question that prompted this study,” said senior researcher Dr. Anuradha Lala, director of heart failure research at Mount Sinai’s Icahn School of Medicine, in New York City.
Based on the findings, she said, new heart failure appears to be uncommon and usually strikes patients with a history of heart disease or stroke, or with risk factors for heart trouble, such as high blood pressure or diabetes. But a handful of patients developed heart failure despite having no risk factors. Exactly why is unclear.
“For now, the mechanisms remain elusive,” Lala said.
There could be various scenarios playing out, according to Lala. When patients do have a history of heart problems or conditions like high blood pressure, she said, it’s possible that COVID-19 “pushes them over the edge” toward heart failure.
For some, it might be the stress of being severely ill in the hospital. But the body’s inflammatory response to SARS-CoV-2, the virus that causes COVID-19, could also play a role.
Dr. Biykem Bozkurt is a professor of medicine at Baylor College of Medicine, in Houston, and a member of the American College of Cardiology’s Science & Quality Committee.
She said that in patients with established heart disease, the physiological stress of a severe case of COVID-19 — including less oxygen getting to the heart — may be one factor precipitating new heart failure.
But more often, Bozkurt said, the heart complication may be driven by an overly aggressive immune response to SARS-CoV-2 and widespread inflammation in the body.
She said that since the pandemic’s start, it’s become clear that COVID-19 can have various cardiac complications: Some patients develop heart attack symptoms, blood clots or an inflammation of the heart muscle called myocarditis.
With heart failure, some symptoms (like breathlessness) do overlap with COVID-19. But doctors have additional ways to pinpoint heart failure, Lala said: They include blood tests that look for elevations in a protein called BNP, and imaging tests that detect certain structural or functional abnormalities in the heart.
How do these patients ultimately fare after they go home from the hospital?
“I think it’s a spectrum,” Bozkurt said. If patients show an improvement in symptoms and objective measures of heart structure and function, that bodes well.
Lala said it’s not clear whether, for some patients with new heart failure, any structural abnormalities in the heart might persist, or whether signs and symptoms could re-emerge.
COVID-19 is still a new disease, both Lala and Bozkurt said, so its long-range effects on the heart remain to be seen.
Bozkurt said that anyone who was hospitalized for COVID-19 and told there was “cardiac involvement” should have follow-up care with a cardiologist.
The latest findings, published online April 26 in the Journal of the American College of Cardiology, are based on over 6,439 patients hospitalized for COVID-19 between February and June 2020.
Overall, 37 patients newly developed heart failure, including eight with no known vulnerabilities. Those latter patients were often quite ill, with five ending up in the intensive care unit.
They were, however, less likely to die than heart failure patients with preexisting cardiovascular disease: One of eight died, versus six of 14.
Lala agreed that patients like these should see a cardiologist for follow-up care.
More broadly, she said, researchers need to keep studying the long-term effects of COVID-19 on the cardiovascular system.
The American Heart Association has more on COVID-19 and the heart.
SOURCES: Anuradha Lala, MD, director, heart failure research, Icahn School of Medicine at Mount Sinai, New York City; Biykem Bozkurt, MD, PhD, professor, medicine, Baylor College of Medicine, Houston, and member, Science & Quality Committee, American College of Cardiology, Washington, D.C.; Journal of the American College of Cardiology, April 26, 2021, online
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