Table 1_Impact of in-hospital SARS-CoV-2 infection on mortality and outcomes in patients admitted for heart failure: a nationwide analysis in Brazil.docx

BackgroundThe effects of COVID-19 on patients hospitalized for heart failure (HF) remain underexplored, especially in middle-income countries. We investigated how in-hospital SARS-CoV-2 infection affected clinical outcomes and healthcare costs among heart failure (HF) patients in Brazil's public health system during the pandemic period, following its official global declaration in early 2020.
MethodsWe performed a retrospective study of 262,758 adults hospitalized for HF in public hospitals across Brazil from January-2020 to August-2021. Patients who acquired COVID-19 during hospitalization (n = 385) were compared to those who remained uninfected (n = 261,907). Demographics, comorbidities, clinical outcomes, and costs were analyzed. Cox regression models identified predictors of in-hospital mortality.
ResultsPatients with COVID-19 had longer hospital stays (median 7 vs. 5 days; p < 0.001), higher need for renal replacement therapy (6.5% vs. 2.6%; p < 0.001), and greater in-hospital mortality (26% vs. 13%; p < 0.001). Hospitalization costs were also higher in the COVID-19 group, both in total (median BRL 1,373 vs. BRL 836; p < 0.001) and per day (BRL 250 vs. BRL 226; p < 0.001). COVID-19 infection increased the risk of in-hospital death by 43% in univariate Cox regression (HR 1.43; 95% CI 1.14–1.68; p = 0.001), and remained independently associated with mortality in multivariable analysis (HR 1.38; 95% CI 1.14–1.68; p = 0.001). Kaplan–Meier analysis demonstrated significantly lower survival in the infected group (log-rank p < 0.001).
ConclusionIn-hospital COVID-19 infection significantly worsens outcomes and increases healthcare costs among patients admitted for HF in Brazil. These findings underscore the need for preventive strategies, including vaccination and timely antiviral therapies, particularly within public health systems.