Heart failure as a complication of COVID-19 infection: systematic review and meta-analysis

The prevalence and prognostic implications of heart failure (HF), as a complication of COVID-19 infection remains unclear. We performed a systematic review and metanalysis aimed to evaluate the pooled incidence of acute HF as a cardiac complication of COVID-19 disease and to estimate the related mortality risk in these patients. Data were obtained searching MEDLINE, Scopus and Web of Science for all investigations published any time to 26 December 2020. If statistical heterogeneity was 50%, the results were derived from the fixed-effects model otherwise the random-effects model. Overall, 1064 patients [mean age 66 years, 618 males] were included in the final analysis reviewing six investigations. The cumulative in-hospital rate of COVID-19 patients complicated by acute HF ranged between 6.9 and 63.4% among the studies reviewed. A random effect model revealed a pooled incidence of COVID-19 patients complicated by acute HF in 20.2% of cases (95% CI: 11.1–33.9%, <i>p</i> &lt; 0.0001 I2 = 94.4%). A second pooled analysis, based on a random-effect model, confirmed a significant increased risk of death in COVID-19 patients complicated by acute HF during the infection (OR 9.36, 95% CI 4.76–18.4, <i>p</i> &lt; 0.0001, I2 = 56.6%). Meta-regression analysis, using age as moderator variable, failed in founding a statistically significant relationship with the incidence of acute HF onset as a complication of COVID-19 disease (<i>p</i> = 0.062) or the mortality risk among the same subjects (<i>p</i> = 0.053). Acute HF represents a frequent complication of COVID-19 infection associated with a higher risk of mortality in the short-term period.

新型冠状病毒肺炎（COVID-19）感染并发心力衰竭（heart failure, HF）的患病率及其预后意义目前仍不明确。本研究开展了一项系统综述与荟萃分析，旨在评估新型冠状病毒肺炎患者并发急性心力衰竭这一心脏并发症的合并发生率，并估算此类患者的相关死亡风险。研究通过检索MEDLINE、Scopus及Web of Science数据库，收集了2020年12月26日之前发表的所有相关研究。若统计学异质性为50%，则采用固定效应模型得出结果；反之则采用随机效应模型。最终共纳入6项研究、1064例患者进行分析，患者平均年龄为66岁，其中男性618例。纳入的研究显示，新型冠状病毒肺炎并发急性心力衰竭患者的院内累计发生率介于6.9%至63.4%之间。随机效应模型分析显示，新型冠状病毒肺炎并发急性心力衰竭的合并发生率为20.2%（95%置信区间：11.1%~33.9%，*p* < 0.0001，I²=94.4%）。第二项基于随机效应模型的合并分析证实，新型冠状病毒肺炎并发急性心力衰竭的患者在感染期间的死亡风险显著升高（比值比OR=9.36，95%置信区间：4.76~18.4，*p* < 0.0001，I²=56.6%）。以年龄为调节变量的Meta回归分析显示，其与新型冠状病毒肺炎并发急性心力衰竭的发生率（*p*=0.062）及此类患者的死亡风险（*p*=0.053）均未达到统计学显著性关联。急性心力衰竭是新型冠状病毒肺炎感染的常见并发症，且与患者短期死亡风险升高显著相关。