Racial and socioeconomic differences for heart failure hospitalizations and follow-up during the COVID-19 pandemic (Preprint)

Abstract

Low rates of heart failure (HF) hospitalizations were observed during the 2020 peak of the COVID-19 pandemic. It is unclear how this affected different racial and socioeconomic groups. It is also unknown whether the shift to telemedicine impacted disparities in follow-up or readmissions.

To determine the effects of the COVID-19 pandemic on acute decompensated heart failure admissions and post-hospitalization follow-up for different socioeconomic as well as racial and ethnic groups.

HF admissions during the initial peak of the pandemic (March 15–June 1, 2020) were compared to the same timeframe in 2019. Patients were stratified by race, ethnicity, and median neighborhood income. Hospital and ICU admission rates, inpatient mortality, 7-day follow-up, and 30-day readmissions were assessed.

Patients in 2020 had higher rates of ICU admission compared to 2019 (16.87% vs 10.96%; P=0.008). This trend was seen across all subgroups and was significant for patients from the highest income quartile (17.89% vs 10.99%; P=0.018) and white patients (16.59% vs 9.52%; P=0.007). While there was a trend towards higher inpatient mortality in 2020 versus 2019 (4.60% vs 2.53%; P=0.077), no difference was seen among different racial and socioeconomic groups. Telemedicine comprised 80.69% of 7-day follow-up in 2020, with improvement in 7-day follow-up rates (43.86% vs 32.58%; P<0.005). Inequities in 7-day follow-up for Black patients compared to white patients decreased during the pandemic. Those with telemedicine follow-up were less likely to be readmitted in 30 days (10.34% vs 33.66%; P<0.005).

There were no major differences in HF admissions for different racial and socioeconomic groups during the COVID-19 pandemic. Inequalities in 7-day follow-up were reduced with the advent of telemedicine and decreased 30-day readmission for those who had follow-up.