The Decrease in Hospitalizations For Heart Failure During the Covid-19 Pandemic: A Community and Academic Hospital Comparison Study

During the novel coronavirus (COVID-19) pandemic, the incidence of cardiovascular hospitalizations has been observed to decrease. The patient behavior, clinician behavior and pathophysiological contributors are currently unclear. We sought to determine if the pattern of heart failure (HF) hospitalizations was the same between 1 Academic Hospital with Advanced HF and Transplant services and 2 Community Hospitals, within a single health system in Massachusetts (MA). The 3 hospitals, Academic/Advanced HF Hospital A, Community Hospital B and Community Hospital C, are all located within 30-mile radius and share many clinical protocols, although HF hospitalizations at Academic/Advanced HF Hospital A include advanced HF therapy referrals and patients listed for heart transplantation. We retrospectively reviewed the weekly adult hospitalizations for HF, defined as patients ≥18 years discharged with a principal diagnosis of HF per ICD-10 coding (I110, I130, I132, I50 subsets) across the 3 hospitals, between January 1 and April 26 in 2019 and 2020. The weekly hospitalization volumes for 2019 and 2020 were displayed as a bar graph, alongside the total MA COVID-19 diagnosis and key dates in the pandemic response, for each hospital. The volume of weekly hospitalizations for HF in March and April 2020 were lower at all 3 hospitals, as compared to 2019 (Figure 1). At Academic/Advanced HF Hospital A, the reduction in weekly HF hospitalizations began in mid-February, prior to the MA ‘state of emergency’ declaration effective March 11 and the ‘stay at home’ order effective March 24, 2020. Conversely, at Community Hospitals B and C the reduction in hospitalizations for HF (compared to 2019) occurred closer to the ‘stay at home’ order. The date on which each hospital formally ramped down non-urgent outpatient visits and procedures occurred first for Academic/Advanced HF Hospital A, but HF hospitalization volume reduction still appeared to precede this announcement. The decrease in hospitalizations for HF during the COVID-19 pandemic began in an Academic/Advanced HF Hospital before the MA ‘state of emergency’ and ‘stay at home’ orders, but around the time of the ‘state of emergency’ order in 2 affiliated Community Hospitals. This observation suggests that the factors driving HF volume during a pandemic may differ across patient populations and hospitals, even within the same region.