Reduced Rate of Hospital Presentations for Heart Failure During the COVID-19 Pandemic in Toronto, Canada

Coronavirus disease 2019 (COVID-19) has resulted in public health measures and health care reconfigurations likely to have impact on chronic disease care. We aimed to assess the volume and characteristics of patients presenting to hospitals with acute decompensated heart failure (ADHF) during the 2020 COVID-19 pandemic compared with a time-matched 2019 cohort. Patients presenting to hospitals with ADHF from March 1, to April 19, 2020 and 2019 in an urban hospital were examined. Multivariable logistic-regression models were used to evaluate the difference in probability of ADHF-related hospitalization between the 2 years. During the COVID-19 pandemic, a total of 1106 emergency department (ED) visits for dyspnea or peripheral edema were recorded, compared with 800 ED visits in 2019. A decrease in ADHF-related ED visits of 43.5% (14.8%-79.4%, P = 0.002) and ADHF-related admissions of 39.3% (8.6%-78.5%, P = 0.009) was observed compared with 2019. Patients with ADHF presenting to hospitals (n = 128) were similar in age, sex, and comorbidities compared with the 2019 cohort (n = 186); however, a higher proportion had recent diagnoses of heart failure. Upon ED presentation, the relative probability of hospitalization or admission to intensive care was not statistically different. There was a trend toward higher in-hospital mortality in 2020. The decline in ADHF-related hospitalizations raises the timely question of how patients with heart failure are managing beyond the acute-care setting and reinforces the need for public education on the availability and safety of emergency services throughout the COVID-19 pandemic. La maladie à coronavirus 2019 (COVID-19) a transformé les stratégies de santé publique et les soins de santé, ce qui risque d’avoir des répercussions sur les soins aux patients atteints d’une maladie chronique. Nous avons comparé le nombre de patients qui se sont présentés à l’hôpital en insuffisance cardiaque aiguë décompensée (ICAD) durant la pandémie de COVID-19 et leurs caractéristiques avec le nombre et les caractéristiques des patients traités durant la même période en 2019. Les dossiers des patients qui se sont présentés en ICAD à un hôpital urbain entre le 1er mars et le 19 avril en 2020 et en 2019 ont donc été examinés. La différence entre les probabilités d’hospitalisation pour ICAD en 2020 et en 2019 a été évaluée au moyen de modèles de régression logistique multivariés. Durant la pandémie de COVID-19, on a dénombré en tout 1 106 consultat