{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T05:10:14Z","timestamp":1790053814047,"version":"4.0.1"},"reference-count":30,"publisher":"Oxford University Press (OUP)","issue":"12","license":[{"start":{"date-parts":[[2020,10,7]],"date-time":"2020-10-07T00:00:00Z","timestamp":1602028800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"},{"start":{"date-parts":[[2020,10,7]],"date-time":"2020-10-07T00:00:00Z","timestamp":1602028800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2020,12,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Data on the impact of COVID-19 in chronic heart failure (CHF) patients and its potential to trigger acute heart failure (AHF) are lacking. The aim of this work was to study characteristics, cardiovascular outcomes and mortality in patients with confirmed COVID-19 infection and a prior diagnosis of heart failure (HF). Further aims included the identification of predictors and prognostic implications for AHF decompensation during hospital admission and the determination of a potential correlation between the withdrawal of HF guideline-directed medical therapy (GDMT) and worse outcomes during hospitalization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>Data for a total of 3080 consecutive patients with confirmed COVID-19 infection and follow-up of at least 30\u2009days were analysed. Patients with a previous history of CHF (n = 152, 4.9%) were more prone to the development of AHF (11.2% vs. 2.1%; P\u2009&amp;lt;\u20090.001) and had higher levels of N-terminal pro brain natriuretic peptide. In addition, patients with previous CHF had higher mortality rates (48.7% vs. 19.0%; P\u2009&amp;lt;\u20090.001). In contrast, 77 patients (2.5%) were diagnosed with AHF, which in the vast majority of cases (77.9%) developed in patients without a history of HF. Arrhythmias during hospital admission and CHF were the main predictors of AHF. Patients developing AHF had significantly higher mortality (46.8% vs. 19.7%; P\u2009&amp;lt;\u20090.001). Finally, the withdrawal of beta-blockers, mineralocorticoid receptor antagonists and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers was associated with a significant increase in in-hospital mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Patients with COVID-19 have a significant incidence of AHF, which is associated with very high mortality rates. Moreover, patients with a history of CHF are prone to developing acute decompensation after a COVID-19 diagnosis. The withdrawal of GDMT was associated with higher mortality.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ejhf.1990","type":"journal-article","created":{"date-parts":[[2020,8,24]],"date-time":"2020-08-24T22:25:47Z","timestamp":1598307947000},"page":"2205-2215","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":217,"title":["Heart Failure in COVID-19 Patients: Prevalence, Incidence and Prognostic Implications"],"prefix":"10.1093","volume":"22","author":[{"given":"Juan R.","family":"Rey","sequence":"first","affiliation":[{"name":"Cardiology Department, Hospital Universitario La Paz , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan","family":"Caro-Cod\u00f3n","sequence":"additional","affiliation":[{"name":"Cardiology Department, Hospital Universitario La Paz , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra O.","family":"Rosillo","sequence":"additional","affiliation":[{"name":"Cardiology Department, Hospital Universitario La Paz , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00c1ngel M.","family":"Iniesta","sequence":"additional","affiliation":[{"name":"Cardiology Department, Hospital Universitario La Paz , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sergio","family":"Castrej\u00f3n-Castrej\u00f3n","sequence":"additional","affiliation":[{"name":"Cardiology Department, Hospital Universitario La Paz , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene","family":"Marco-Clement","sequence":"additional","affiliation":[{"name":"Cardiology Department, Hospital Universitario La Paz , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorena","family":"Mart\u00edn-Polo","sequence":"additional","affiliation":[{"name":"Cardiology Department, Hospital Universitario La Paz , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos","family":"Merino-Argos","sequence":"additional","affiliation":[{"name":"Cardiology Department, Hospital Universitario La Paz , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Rodr\u00edguez-Sotelo","sequence":"additional","affiliation":[{"name":"Cardiology Department, Hospital Universitario La Paz , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose M.","family":"Garc\u00eda-Veas","sequence":"additional","affiliation":[{"name":"Cardiology Department, Hospital Universitario La Paz , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis A.","family":"Mart\u00ednez-Mar\u00edn","sequence":"additional","affiliation":[{"name":"Cardiology Department, Hospital Universitario La Paz , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcel","family":"Mart\u00ednez-Cossiani","sequence":"additional","affiliation":[{"name":"Cardiology Department, Hospital Universitario La Paz , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Bu\u00f1o","sequence":"additional","affiliation":[{"name":"Clinical Analytics, Hospital Universitario La Paz , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis","family":"Gonzalez-Valle","sequence":"additional","affiliation":[{"name":"Pharmacy Department, Hospital Universitario La Paz , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alicia","family":"Herrero","sequence":"additional","affiliation":[{"name":"Pharmacy Department, Hospital Universitario La Paz , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9 L.","family":"L\u00f3pez-Send\u00f3n","sequence":"additional","affiliation":[{"name":"Cardiology Department, Hospital Universitario La Paz , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9 L.","family":"Merino","sequence":"additional","affiliation":[{"name":"Cardiology Department, Hospital Universitario La Paz , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"for the CARD-COVID Investigators","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,10,7]]},"reference":[{"key":"2026011721384491400_ejhf1990-bib-0001","doi-asserted-by":"crossref","first-page":"1054","DOI":"10.1016\/S0140-6736(20)30566-3","article-title":"Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study","volume":"395","author":"Zhou","year":"2020","journal-title":"Lancet"},{"key":"2026011721384491400_ejhf1990-bib-0002","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1016\/j.jchf.2018.10.011","article-title":"Effect of influenza on outcomes in patients with heart failure","volume":"7","author":"Panhwar","year":"2019","journal-title":"JACC Heart Fail"},{"key":"2026011721384491400_ejhf1990-bib-0003","doi-asserted-by":"crossref","first-page":"978","DOI":"10.1002\/ejhf.1925","article-title":"The impact of COVID-19 on heart failure hospitalization and management: report from a heart failure unit in London during the peak of the pandemic","volume":"22","author":"Bromage","year":"2020","journal-title":"Eur J Heart Fail"},{"key":"2026011721384491400_ejhf1990-bib-0004","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1002\/ejhf.1494","article-title":"Heart Failure Association of the European Society of Cardiology practical guidance on the use of natriuretic peptide concentrations","volume":"21","author":"Mueller","year":"2019","journal-title":"Eur J Heart Fail"},{"key":"2026011721384491400_ejhf1990-bib-0005","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1093\/ehjci\/jev014","article-title":"Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging","volume":"16","author":"Lang","year":"2015","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"2026011721384491400_ejhf1990-bib-0006","doi-asserted-by":"crossref","first-page":"2736","DOI":"10.1161\/CIRCULATIONAHA.110.009449","article-title":"Standardized bleeding definitions for cardiovascular clinical trials: a consensus report from the Bleeding Academic Research Consortium","volume":"123","author":"Mehran","year":"2011","journal-title":"Circulation"},{"key":"2026011721384491400_ejhf1990-bib-0007","doi-asserted-by":"crossref","first-page":"1821","DOI":"10.1093\/eurheartj\/ehaa388","article-title":"Characteristics and outcomes of patients hospitalized for COVID-19 and cardiac disease in Northern Italy","volume":"41","author":"Inciardi","year":"2020","journal-title":"Eur Heart J"},{"key":"2026011721384491400_ejhf1990-bib-0008","doi-asserted-by":"crossref","first-page":"941","DOI":"10.1002\/ejhf.1915","article-title":"Management of heart failure patients with COVID-19: a joint position paper of the Chinese Heart Failure Association & National Heart Failure Committee and the Heart Failure Association of the European Society of Cardiology","volume":"22","author":"Zhang","year":"2020","journal-title":"Eur J Heart Fail"},{"key":"2026011721384491400_ejhf1990-bib-0009","doi-asserted-by":"crossref","first-page":"2049","DOI":"10.1056\/NEJMsb2005114","article-title":"Fair allocation of scarce medical resources in the time of Covid-19","volume":"382","author":"Emanuel","year":"2020","journal-title":"N Engl J Med"},{"key":"2026011721384491400_ejhf1990-bib-0010","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1016\/S0140-6736(12)61266-5","article-title":"Acute pneumonia and the cardiovascular system","volume":"381","author":"Corrales-Medina","year":"2013","journal-title":"Lancet"},{"key":"2026011721384491400_ejhf1990-bib-0011","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1001048","article-title":"Cardiac complications in patients with community-acquired pneumonia: a systematic review and meta-analysis of observational studies","volume":"8","author":"Corrales-Medina","year":"2011","journal-title":"PLoS Med"},{"key":"2026011721384491400_ejhf1990-bib-0012","author":"European Society of Cardiology"},{"key":"2026011721384491400_ejhf1990-bib-0013","doi-asserted-by":"crossref","first-page":"592","DOI":"10.1093\/ehjci\/jeaa072","article-title":"COVID-19 pandemic and cardiac imaging: EACVI recommendations on precautions, indications, prioritization, and protection for patients and healthcare personnel","volume":"21","author":"Skulstad","year":"2020","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"2026011721384491400_ejhf1990-bib-0014","doi-asserted-by":"crossref","first-page":"1000","DOI":"10.1001\/jamacardio.2018.2568","article-title":"Association of natriuretic peptides with cardiovascular prognosis in heart failure with preserved ejection fraction: secondary analysis of the TOPCAT randomized clinical trial","volume":"3","author":"Myhre","year":"2018","journal-title":"JAMA Cardiol"},{"key":"2026011721384491400_ejhf1990-bib-0015","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1016\/j.jchf.2019.12.010","article-title":"Natriuretic peptides as inclusion criteria in clinical trials: a JACC heart failure position paper","volume":"8","author":"Ibrahim","year":"2020","journal-title":"JACC Heart Fail"},{"key":"2026011721384491400_ejhf1990-bib-0016","doi-asserted-by":"crossref","DOI":"10.1001\/jamacardio.2020.1017","article-title":"Cardiovascular implications of fatal outcomes of patients with coronavirus disease 2019 (COVID-19)","volume":"5","author":"Guo","year":"2020","journal-title":"JAMA Cardiol"},{"key":"2026011721384491400_ejhf1990-bib-0017","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1001\/jamacardio.2020.3557","article-title":"Outcomes of cardiovascular magnetic resonance imaging in patients recently recovered from coronavirus disease 2019 (COVID-19)","volume":"5","author":"Puntmann","year":"2020","journal-title":"JAMA Cardiol"},{"key":"2026011721384491400_ejhf1990-bib-0018","doi-asserted-by":"crossref","first-page":"769","DOI":"10.1016\/j.recesp.2020.05.013","article-title":"Arterial thrombotic complications in hospitalized patients with COVID-19","volume":"73","author":"Rey","year":"2020","journal-title":"Rev Esp Cardiol (Engl Ed)"},{"key":"2026011721384491400_ejhf1990-bib-0019","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1056\/NEJMoa2015432","article-title":"Pulmonary vascular endothelialitis, thrombosis, and angiogenesis in Covid-19","volume":"383","author":"Ackermann","year":"2020","journal-title":"N Engl J Med"},{"key":"2026011721384491400_ejhf1990-bib-0020","doi-asserted-by":"crossref","first-page":"1123","DOI":"10.1161\/CIRCULATIONAHA.120.049465","article-title":"Unexpected features of cardiac pathology in COVID-19 infection","volume":"142","author":"Fox","year":"2020","journal-title":"Circulation"},{"key":"2026011721384491400_ejhf1990-bib-0021","doi-asserted-by":"crossref","first-page":"808","DOI":"10.1093\/eurjhf\/hft050","article-title":"EURObservational Research Programme: regional differences and 1-year follow-up results of the Heart Failure Pilot Survey (ESC-HF Pilot)","volume":"15","author":"Maggioni","year":"2013","journal-title":"Eur J Heart Fail"},{"key":"2026011721384491400_ejhf1990-bib-0022","doi-asserted-by":"crossref","first-page":"e437","DOI":"10.1016\/S2665-9913(20)30121-1","article-title":"Immune mechanisms of pulmonary intravascular coagulopathy in COVID-19 pneumonia","volume":"2","author":"McGonagle","year":"2020","journal-title":"Lancet Rheumatol"},{"key":"2026011721384491400_ejhf1990-bib-0023","doi-asserted-by":"crossref","first-page":"3058","DOI":"10.1093\/eurheartj\/ehaa500","article-title":"Pulmonary embolism in COVID-19 patients: a French multicentre cohort study","volume":"41","author":"Fauvel","year":"2020","journal-title":"Eur Heart J"},{"key":"2026011721384491400_ejhf1990-bib-0024","first-page":"e962","article-title":"Response to letter regarding article, \u2018Atrial fibrillation begets heart failure and vice versa: temporal associations and differences in preserved versus reduced ejection fraction","volume":"133","author":"Santhanakrishnan","year":"2016","journal-title":"Circulation"},{"key":"2026011721384491400_ejhf1990-bib-0025","doi-asserted-by":"crossref","first-page":"1671","DOI":"10.1161\/CIRCRESAHA.120.317134","article-title":"Association of inpatient use of angiotensin converting enzyme inhibitors and angiotensin II receptor blockers with mortality among patients with hypertension hospitalized with COVID-19","volume":"126","author":"Zhang","year":"2020","journal-title":"Circ Res"},{"key":"2026011721384491400_ejhf1990-bib-0026","doi-asserted-by":"crossref","first-page":"2431","DOI":"10.1056\/NEJMoa2006923","article-title":"Renin\u2013angiotensin\u2013aldosterone system blockers and the risk of Covid-19","volume":"382","author":"Mancia","year":"2020","journal-title":"N Engl J Med"},{"key":"2026011721384491400_ejhf1990-bib-0027","doi-asserted-by":"crossref","first-page":"2441","DOI":"10.1056\/NEJMoa2008975","article-title":"Renin\u2013angiotensin\u2013aldosterone system inhibitors and risk of Covid-19","volume":"382","author":"Reynolds","year":"2020","journal-title":"N Engl J Med"},{"key":"2026011721384491400_ejhf1990-bib-0028","doi-asserted-by":"crossref","first-page":"2058","DOI":"10.1093\/eurheartj\/ehaa433","article-title":"Association of hypertension and antihypertensive treatment with COVID-19 mortality: a retrospective observational study","volume":"41","author":"Gao","year":"2020","journal-title":"Eur Heart J"},{"key":"2026011721384491400_ejhf1990-bib-0029","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1016\/j.ahj.2020.05.002","article-title":"Continuing versus suspending angiotensin-converting enzyme inhibitors and angiotensin receptor blockers: impact on adverse outcomes in hospitalized patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) \u2013 the BRACE CORONA Trial","volume":"226","author":"Lopes","year":"2020","journal-title":"Am Heart J"},{"key":"2026011721384491400_ejhf1990-bib-0030","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1016\/S0140-6736(18)32484-X","article-title":"Withdrawal of pharmacological treatment for heart failure in patients with recovered dilated cardiomyopathy (TRED-HF): an open-label, pilot, randomised trial","volume":"393","author":"Halliday","year":"2019","journal-title":"Lancet"}],"container-title":["European Journal of Heart Failure"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ejhf.1990","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ejhf.1990","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/academic.oup.com\/eurjhf\/article-pdf\/22\/12\/2205\/66111100\/eurjhf_22_12_2205.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/eurjhf\/article-pdf\/22\/12\/2205\/66111100\/eurjhf_22_12_2205.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,18]],"date-time":"2026-01-18T02:41:15Z","timestamp":1768704075000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/eurjhf\/article\/22\/12\/2205\/8384499"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,10,7]]},"references-count":30,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2020,10,7]]},"published-print":{"date-parts":[[2020,12,1]]}},"URL":"https:\/\/doi.org\/10.1002\/ejhf.1990","relation":{},"ISSN":["1388-9842","1879-0844"],"issn-type":[{"value":"1388-9842","type":"print"},{"value":"1879-0844","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2020,12]]},"published":{"date-parts":[[2020,10,7]]},"assertion":[{"value":"2020-06-21","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-08-18","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-10-07","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}