Managing Covid-19 in patients with heart failure: current status and future prospects

ABSTRACT

Introduction

COVID-19 may contribute to decompensation of previously stable chronic HF or cause a de-novo heart failure, which may come from the hyperinflammatory response and subsequent increase in metabolic demand.

Areas covered

Two independent investigators searched MEDLINE (via PubMed), Europe PMC, and ScienceDirect databases with the following search terms: COVID-19, heart failure, COVID-19 drugs, heart failure drugs, and device therapy. All of the included full-text articles were rigorously evaluated by both authors in case there was disagreement about whether research should be included or not. In total, 157 studies were included and underwent extensive reading by the authors.

Expert opinion

The World Health Organization (WHO) and the National Institute of Health (NIH) have published COVID-19 drug recommendations, although recommendations for HF-specific drug choices in COVID-19 are still lacking. We hope that this review can answer the void of comprehensive research data regarding the management options of HF in the COVID-19 condition so that clinicians can at least choose a more beneficial therapy or avoid combination therapies that have a high burden of side effects on HF; thus, morbidity and mortality in COVID-19 patients with HF may be reduced.

KEYWORDS:

• COVID-19
• heart failure
• mortality
• morbidity
• drug interaction

Article highlights

• Heart failure and COVID-19 share complex pathophysiology, which can elevate the morbidity and mortality risk even further.

• In COVID-19 patients, heart failure may occur as a de novo heart failure, chronic heart failure, or long-term complications due to long COVID.

• Heart failure and COVID-19 therapeutical options have advantages and disadvantages that affect patients’ clinical conditions.

• Drug interaction is sometimes a forgotten factor yet one of the essential factors to help clinicians choose the best therapeutical options for the patient.

• In determining the optimal treatment strategy for COVID-19 and heart failure, clinicians must weigh the benefit and risks of each treatment approach to minimize and avoid the potential adverse event.

• Given the lack of recent studies investigating the bidirectional association of COVID-19 and heart failure medication, more studies are required to address this data gap.

Declaration of Interests

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.