COMPARATIVE ANALYSIS OF COMPLICATIONS ASSOCIATED WITH CHRONIC HEART FAILURE AND ATRIAL FIBRILLATION

ABSTRACT

Patients with chronic heart failure (CHF) and atrial fibrillation (AF) represent a vulnerable population with high risks of cardiovascular and thromboembolic complications. This study aimed to comparatively analyze the frequency and characteristics of complications in CHF and AF patients with and without a history of COVID-19 infection. A total of 285 elderly patients (aged 60–74) were divided into two groups: Group 1 (n=145) included patients with CHF, AF, and previous COVID-19 infection, and Group 2 (n=140) included patients with CHF and AF without COVID-19. Retrospective data analysis was performed focusing on thromboembolic events, bleeding episodes, cardiac decompensation, arrhythmias, and infectious complications. The incidence of thromboembolic events such as pulmonary embolism (12.4% vs. 5%, p<0.01) and ischemic stroke (15% vs. 8%, p<0.05) was significantly higher in the COVID-19 group. Major and minor bleeding events were also more frequent in Group 1 (10% and 20% vs. 4.3% and 12.1%, respectively, p<0.05). Cardiac complications, including heart failure decompensation and ventricular tachyarrhythmias, occurred at higher rates in patients with prior COVID-19. Additionally, bacterial pneumonia incidence was elevated (7.6% vs. 1.4%, p<0.05). These findings underscore the exacerbating effect of COVID-19 on the severity and frequency of complications in CHF and AF patients, highlighting the need for tailored clinical management and anticoagulant dosing.

АННОТАЦИЯ

Хроническая сердечная недостаточность (ХСН) и фибрилляция предсердий (ФП) представляют собой потенциально уязвимую популяцию с наибольшим риском сердечно-сосудистых и тромбоэмболических событий. Целью данного исследования было сравнить распространенность и типы осложнений у пациентов с ХСН и ФП с COVID-19 и без него. В когорте участвовали 285 пожилых (в возрасте 60–74 лет) участников, разделенных на 1-ю (n=145) и 2-ю (n=140) группы, где первая группа включала пациентов с ХСН, ФП и историей COVID-19. Был проведен ретроспективный обзор данных для оценки тромбоэмболических событий, кровотечений, декомпенсации сердечной недостаточности, аритмий и инфекционных осложнений. У пациентов с COVID-19 была значительно выше распространенность тромбоэмболических событий (тромбоэмболия легочной артерии, 12,4% против 5%, p<0,01; и ишемический инсульт, 15% против 8%, p<0,05). Кроме того, крупные и мелкие кровотечения были более частыми в 1-й группе (10% и 20% против 4,3% и 12,1% соответственно, p<0,05). Сердечные осложнения, включая декомпенсацию сердечной недостаточности и желудочковые тахиаритмии, были более распространены у пациентов с существующей инфекцией COVID-19. Бактериальная пневмония также была распространена (7,6% против 1,4%, p<0,05). Представленные результаты согласуются с ухудшением исходов COVID-19, как по тяжести, так и по частоте осложнений у пациентов с ХСН и ФП, с акцентом на персонализированное клиническое лечение и дозировки антикоагулянтов. Ключевые слова: хроническая сердечная недостаточность; фибрилляция предсердий; COVID-19; тромбоэмболия; кровотечение; декомпенсация сердца; аритмии; пневмония.

Keywords: chronic heart failure, atrial fibrillation, COVID-19, thromboembolism, bleeding, cardiac decompensation, arrhythmias, pneumonia.

Ключевые слова: хроническая сердечная недостаточность, фибрилляция предсердий, COVID-19, тромбоэмболия, кровотечения, декомпенсация сердца, аритмии, пневмония.

INTRODUCTION

CHF is associated with altered cardiac pumping and insufficient systemic perfusion, while AF manifests as irregular and frequently fast heart rhythm, elevating the risk of thromboembolism. CHF and AF are both independently and in combination related risk factors for adverse events such as stroke, hospitalization, or death. The emergence of COVID-19 has posed novel challenges to cardiovascular disease [1;128]. Led by SARS-CoV-2 virus, COVID-19 is known to have directly induced cardiovascular-system effects via viral infection, systemic inflammation and endothelial dysfunction. Patients with pre-existing cardiovascular diseases, particularly CHF and AF, become increasingly susceptible to severe complications related to COVID-19. Based on recent evidence, it is clear that COVID-19 infection induces a hypercoagulable phase with an increased risk of thromboembolic events; pulmonary embolism (PE); and ischemic stroke [2; 373-498]. Moreover, COVID-19-related inflammation and hypoxia aggravate cardiac dysfunction with consequent decompensation and arrhythmias. However, very few comparative studies exist to estimate the frequency and range of complications among CHF and AF patients with and without COVID-19 infection. Recognizing these differences is essential in order to maximize clinical management and minimize morbidity and mortality in this patient population. This study examines thromboembolic, hemorrhagic, cardiac and infectious complications in elderly patients with CHF and AF, and contrasts those with previous COVID-19 infection against a population without, in hopes of future risk stratification and therapeutic strategies in these cases [3; 209-216].

MATERIALS AND METHODS OF RESEARCH

This retrospective cohort study identified 285 elderly patients aged 60-74 years with a diagnosis of chronic heart failure (CHF) and atrial fibrillation (AF) who were treated in the cardiology department of the Andijan State Medical Institute, Uzbekistan. Participants were grouped into two groups according to their history of COVID-19 infection: Group 1 (n=145 patients) with a previous COVID-19 documented infection and Group 2 (n=140 patients), patients had no known previous COVID-19 infection [4; 528]. We enrolled 285 older adults (aged 60-74 y) with CHF and AF. Of these, 138 (48.4%) were women and 147 (51.6%) were men. The study was conducted in the cardiology department at Andijan State Medical Institute, Andijan region. According to the presence and absence of viral infection in medical history, patients were placed into two groups:

Group 1 (n=145): CHF, AF, COVID-19

Group 2 (n=140): CHF and AF, without COVID-19 infection

Methods: Patient data and medical histories were analyzed retrospectively. Thromboembolic events, bleeding, cardiac events and infectious complications were reviewed [5; 34–45]. These data showed a significantly higher incidence of thromboembolic events in patients with COVID-19. A pulmonary embolism (PE) was present in 12% of patients under Group 1 compared with 5% under Group 2. Simultaneously, ischemic stroke was noted in 15% in Group 1, and 8% in Group 2.

Figure 1. The frequency of occurrence of analyzed complications

We found that an increased bleeding risk among those with COVID-19 related to coagulopathy on anticoagulant medications is associated with the analysis of bleeding events. Major and minor bleeding events were identified for the study. Major bleeding was seen in 10% of individuals diagnosed with COVID-19 (group 1) and 4% of patients without COVID-19 (group 2). Minor bleeding was recorded in 20% and 12% of group 1 and group 2 patients. Our findings thus indicate the need for careful dose determination and patient follow-up during anticoagulant treatment.

Figure 2. The frequency of occurrence of analyzed complications

This also means that there was an obvious correlation between infection and heart complications among patients included in this study, and that SAcute decompensation of the UE happened in 25% of patients in group 1 and 15% in group 2. A large contrast in ventricular tachyarrhythmias frequency can also be seen, with this as an outcome indicator found in 18% and 10% of patients in group 1 and 2. Infectious complications analysis showed bacterial pneumonia in group 1 occurred at 7.6% (<0.05) among the cases we studied and 1.4% in group 2. The reliability- interval analysis was (0.067, 0.173) in group 1. This suggests that the appropriate proportion, i.e., the frequency of thromboembolism, for patients with COVID-19 is almost certainly between 6.7 and 17.3 percent. The data for group 2 is (0.015, 0.085), and the thromboembolic event frequency, in group 2 patients is between 1.5 to 8.5%, is most commonly. Thus the rate of thromboembolism in group 1 patients is higher than before. These intervals were seen comparing groups.

RESULTS AND DISCUSSION

Thromboembolic Complications. In patients with prior COVID-19 infection (Group 1), thromboembolic complications were significantly recurrent and reported to be more common. Group 1 had an impact of 12.4% of these patients had pulmonary embolism (PE), whereas Group 2 had 5% (p<0.01). Likewise, ischemic stroke was seen in 15% of Group 1 and in only 8% of Group 2 (p<0.05). This marked rise would also be consistent with emerging evidence showing that COVID-19 induce a hypercoagulable state by endothelial injury, cytokine storm, and/or platelet activation. Confidence interval analysis confirmed this robustness, with thromboembolism in Group 1 estimated to be 6.7% to 17.3%, well above the 1.5% to 8.5% rate for Group 2. These results emphasize that patients with CHF and AF with previous COVID-19 experience significantly increased odds of thrombus events, emphasizing the need for monitoring and prophylaxis strategies for anticoagulation. Bleeding Events. Indeed, patients developing COVID-19 also suffered from more bleeding complications as a result of anticoagulant therapy due to COVID-associated coagulopathy. Major bleeding events occurred in 10% of Group 1 compared to 4.3% of Group 2 (p<0.05). We observed minor bleeding in 20% of Group 1 versus 12.1% of Group 2 (p<0.05). The study also noted that the striking of a balance between thromboembolism prevention and bleeding sequelae in our current population is especially complex. Careful individualized dosing and frequent monitoring of anticoagulation therapy is necessary in order to minimize hemorrhagic risks. These data also underline the importance of developing and implementing fine-tuned anticoagulation guidelines tailored specifically for patients with previous COVID-19 infection 

Cardiac complications. Patients presenting with COVID-19 had significantly more rate of cardiac decompensation 25% of the patients developing acute CHF exacerbation compared to 15% in controls (p<0.05). Ventricular tachyarrhythmias were seen in 18% and 10% of Group 1 and Group 2, respectively (p<0.05). These cardiac events are likely attributable to the inflammatory milieu, hypoxia and myocardial injury associated with COVID-19. These arrhythmias and decompensations serve to further escalate clinical profiles. Infectious Complications. For the COVID-19 condition, bacterial pneumonia occurred at a much higher rate (7.6%) than for the non-COVID condition (1.4%, p<0.05). The higher incidences may reflect immune suppression and lung tissue damage induced by COVID-19, causing the secondary infection susceptibility. This population is one among which preventive measures such as vaccination, early detection of infections, and prompt antibiotic therapy are very important. Implication and Clinical Recommendations. This broad view indicates that previous COVID-19 infection increases the level and severity of a range of complications in elderly CHF and AF patients. The combined effects of hypercoagulability, inflammation, and myocardial stress are predisposing to thromboembolic and cardiac adverse reactions and anticoagulants in this setting elevate bleeding rates. Multidisciplinary care with the involvement of cardiovascular pathology, hematology and infectious disease knowledge is crucial for clinical control. Incorporating individualized anticoagulant strategies with rigorous monitoring for bleeding with continuous monitoring of cardiac function is critical. Early detection and treatment of infections would help to minimize further complications. More prospective studies are needed to define control strategies and enhance prevention outcomes among this at-risk group [6; 23-34].

CONCLUSION

Here we found that COVID-19 infection has substantially upregulated the risk and incidence of complications of chronic heart failure and atrial fibrillation. Patients with former COVID-19 have much higher rates of thromboembolic events (i.e., pulmonary embolism, ischemic stroke). They also have a markedly elevated risk for major and minor bleeding, where appropriate anticoagulant dose is needed. Moreover, the presence of cardiovascular complications (acute decompensation of heart failure and ventricular tachyarrhythmias) is more frequent in COVID-19 patients, further underlining the role of systemic inflammation and hypoxia in cardiac disease. In addition, for such patients, bacterial pneumonia is also more frequent and likely due to immune suppression from COVID-19 and lung injury. These findings underscore the need for distinct clinical strategies and prevention methods for thromboembolism, bleeding risk reduction and underlying management of existing and/or novel cardiac and infectious complications. Enhanced surveillance and personalised therapies will be important for improvement in this high-risk population and for achieving optimal prognosis.

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