Abstract
Objective: Heart failure is a common sequela of third-degree heart block. This study examines trends in mortality and utilization of medical resources before and during the COVID-19 pandemic in patients with heart failure and third-degree heart block. We also seek to investigate outcomes for different patient demographics, hospital characteristics, and related medical comorbidities. Methods: Hospital admissions of adults with a primary diagnosis of heart failure and a history of third-degree heart block during the period between 2017 and 2022 were selected from the Healthcare Cost and Utilization Project National Inpatient Sample. The primary outcome was all-cause mortality; secondary outcomes were hospital length of stay and total hospital charges. Propensity matching was performed to account for differences between the two sample populations and reduce selection bias. Mortality was analyzed using logistic regression; the secondary outcomes were analyzed by using linear regression. Results: There were 22,900 prepandemic (2017-2019) hospitalizations of patients with heart failure and third-degree heart block and 37,530 hospitalizations during the pandemic (2020-2022). There was no associated difference in all-cause mortality (p = 0.36), length of hospital stay (p = 0.066), or total hospital charges (p = 0.65) during the pandemic. An increased odds of in-hospital mortality was associated with the presence of chronic pulmonary disease [odds ratio (OR): 1.79, 95% confidence interval (CI): 1.07-3.01, p = 0.027], valvular disease (OR: 1.63, 95% CI: 1.01-2.63, p = 0.046), uncomplicated diabetes (OR: 1.89, 95% CI: 1.02-3.51, p = 0.042), liver disease (OR: 3.22, 95% CI: 1.79-5.79, p < 0.001), and coagulopathy (OR: 1.97, 95% CI: 1.18-3.30, p = 0.010). Conclusion: There was no change in all-cause mortality length of stay or total charges of hospitalized patients with heart failure and a history of third-degree heart block during the COVID-19 pandemic as compared to before the pandemic. Certain comorbidities, however, were associated with higher mortality in this population.