The Relation Between Heart Failure and Severity COVID-19 Disease

Silmi Kafa Hanifa and Diana Laila Rahmatillah

Faculty of Pharmacy, Universitas 17 Agustus 1945 Jakarta, Indonesia

Keywords: COVID-19, Comorbid Impact, Heart Failure.

Abstract: This study aims to learn the relationship between heart failure and COVID-19 severity. This study aim to

find out is there any correlation between patient with heart failure and COVID-19. This study employed a

retrospective observational cohort research methodology. Analyzing a number of patient medical records

based on preset categories and examining the convenience sampling employed in this study approach

constituted the data collection technique. This research was conducted in one of this hospital in Bekasi. This

study applies several criteria including: A) Inclusion criteria: all patients with heart failure with Covid 19

infection who were treated in the ICU or were not treated in the ICU, and patients aged 18 years or older. B)

Exclusion criteria: pregnant individuals, autoimmune patients and cancer patients. The result of this study

from 150 patient, 80 female and 70 male most of the patients who have confirmed infection with COVID-19

patients with comorbid heart failure generally have a history of hypertension. Cardiovascular damage with

COVID-19 is associated patients with cardiovascular comorbidities are more susceptible to SARS-CoV-2

contamination and may have more extreme clinical symptoms, possibly because of the association with

patients with ACE2 articulation in this collection than patients without cardiovascular comorbidities.

1 INTRODUCTION

Covid-19 is a medical problem brought on by the

SARS-CoV-2 virus. Covid was first discovered in

December 2021 in Wuhan, Hubei Province, China.

SARS- CoV-2 is transmitted from bats (Rhinolophus

hipposideros) to humans via zoonotic transmission.

As of 1 June 2022, the global rate of confirmed

COVID-19 cases has reached over 532 million, with a

death rate of over 6.3 million. Covid-19 manifests

with fever, cough, shortness of breath, diarrhea,

headache, conjunctivitis, sneezing, and loss of smell

and taste (Clekrin, 2020)

Heart disease is prevalent among Covid-19

patients (Ahsan, 2017). Several studies on heart

disease in Covid infection found that the prevalence

of patients with heart disease complications had a

high morbidity rate, and according to some

researchers, heart disease was caused by a variety of

factors, including age, heredity, stress, excessive

alcohol consumption, smoking, and an unhealthy

lifestyle (Iwashima, 2019).

1.1 Covid-19

Covid disease 2019 is an additional intolerable

infection brought on by Severe Acute Respiratory

Syndrome Corona Infection 2 (SARS-CoV-2)

(Jayanama, 2021). Originally, the disease was

known as the 2019 Covid Novel (2019-nCoV).

Coronavirus was identified for the first time in 2019

in Wuhan, Hubei, China (L, 2020). The World

Health Organization declared Covid-19 a pandemic

on March 11, 2022. (Al-Awwal, N, 2020).

Coronaviruses are members of the family

Coronaviradae (Shi, S, 2020). In China, the virus

began to spread between mid-January and late

January (T., Chen, 2020). Covid-19 is a crown-

shaped RNA virus with a diameter between 60 and

140 nanometers. It is transmitted via inhalation,

specifically through coughing and sneezing. By

inhalation, the Covid-19 virus enters the human

nasal system and begins to replicate. Covid-19's

primary receptor is ACE2 Coronavirus, which is

classified as a zoonotic virus, meaning it can be

transmitted from animals to humans (L, 2020)

1.2 Heart Failure

In addition to complications associated with Covid-

19 infection, such as pneumonia, Covid-19 can cause

damage to numerous organs, including the heart

Hanifa, S. and Rahmatillah, D.

The Relation Between Heart Failure and Severity COVID-19 Disease.

DOI: 10.5220/0011978700003582

In Proceedings of the 3rd International Seminar and Call for Paper (ISCP) UTA â

Z45 Jakarta (ISCP UTA’45 Jakarta 2022), pages 201-205

ISBN: 978-989-758-654-5; ISSN: 2828-853X

 2023 by SCITEPRESS – Science and Technology Publications, Lda. Under CC license (CC BY-NC-ND 4.0)

201

(Shi, S, 2020). In addition to the injuries caused by

Covid-19, many patients have a history of heart

disease prior to contracting the virus, so the

prognosis caused by Covid-19 will have a negative

impact (Wang, T, 2020).

Cardiovascular damage is a condition

characterized by irregularities. in the design or

capacity of the heart that prevents it from working

optimally in that state in all body tissues (Kikuchi, T,

2019). Coronary disease is a disease with a high

mortality and morbidity rate in Indonesia that is on

the rise. CHF (Chronic Heart Failure) causes

aspiration failure, which results in accumulation of

alveolar fluid, and pneumonia caused by Covid-19

disease can also cause accumulation of fluid in the

lungs, which can destroy the estimated Covid-19

contamination. The leading causes are pressure,

heredity, congenital coronary disease, and

cardiomyopathy (Jayanama, K, 2021).

1.3 Role of Heart Failure

Pathophysiology in Covid-19

The renin-angiotensin skeleton (RAS) leads to

cardiovascular disorders such as hypertension, heart

disease, and cardiovascular damage (Zheng, Y,

2020). The SRA comprises of angiotensinogen,

renin, angiotensin II, angiotensin II receptors (AT1

and AT2), and angiotensin- changing over compound

(ACE).

It has been determined that ACE is a compound

that catalyzes the conversion of angiotensin I to

angiotensin II, which is involved in vasoconstriction

and expansion of circulating pressure. Within the

past two decades, a second ACE homologue, ACE2,

has been identified (J. H., 2011). This material is a

counterregulatory chemical that can convert

angiotensin II into vasodilator angiotensin, thereby

reducing the effects of vasoconstriction, sodium

maintenance, and fibrosis.

2 RESEARCH METHODS

This study employed a retrospective observational

cohort research methodology. Analyzing a number

of patient medical records based on preset categories

and examining the convenience sampling employed

in this study approach constituted the data collection

technique.

This study was conducted at Sentra Medika

Cikarang Hospital. The study was conducted from

July through Agust of 2022. A) Inclusion criteria: all

patients with heart failure with Covid 19 infection

who were treated in the ICU or were not treated in

the ICU, and patients aged 18 years or older. B)

Exclusion criteria: pregnant individuals, autoimmune

patients and cancer patients.

2.1 Participant

The participants in this study were 150 patients who

had heart failure and were infected with covid 19,

which was in accordance with the inclusion that had

been set.

2.2 Data Analysis

The result of the research that was carried out at the

sentra medika cikarang hospital, sample taken was

150 patients patients who had heart failure and were

infected with covid 19.

The data was then analyzed in groups using excel

software and then the data was distributed using

SPSS statistical software version 25 to see a relation

between the severity of heart failure patients infected

with Covid-19 with the man withney, chis squared,

the kaplan mayer method

2.3 Instrument

This study uses medical record data patient who had

heart failure and were infected with covid 19 was

150 patients.

2.4 Ethical Approval

Ethical approval was obtained prior to conducting

the study. The ethical approval was sourced from the

health research ethics committee of the Universitas

17 Agustus 1945, Jakarta, with the approval letter

No.39/KEPK- UTA45JKT/EC/EXP/07/2022

3 RESULT

Table 1: Correlation Age and Blood Pressure with Clinical

Outcome.

Facto

Mean

-value

Age

Survive = 34

(50.67) Dead =

114 (57)

0.0001*

Blood Pressure

Before ICU

Survive = 34

(150.50) Dead

= 114 (149.81)

0.905*

Blood Pressure

After ICU

Survive = 34

(137) Dead = 114

(135.53)

0.951*

* Mann Whitney

ISCP UTA’45 Jakarta 2022 - International Seminar and Call for Paper Universitas 17 Agustus 1945 Jakarta

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Table 2: Correlation between Diagnosis with Clinical

Outcome.

Factor

Survive (n =

36)

Dead (n =

114)

Value

Comorbidit y

Diabetes = 6

Hypertens

ion = 11

Without

Comorbidit

y = 19

Diabetes = 1

Hypertens

ion = 42

Without

Comorbidit

y = 71

0.002 #

Grade

Moderate =

14 Severe =

10 Critical

illness = 12

Moderate = 8

Severe =

13 Critical

Illness = 93

0.0001 #

CT-Scan

Pile up = 15

Spread = 21

Pile up = 52

Spread = 62

0.705

# Chi-squared

Whitney method to determine the relationship

between age and blood pressure and clinical

outcomes (Pitidhammabhorn, D, 2021).

Figure 1: The Kaplan Meier Survival Analysis.

Frequently, abnormal blood pressure is

connected with the occurrence of heart failure,

which can be deadly, and heart failure is still a

disease with a high mortality rate, heart failure being

comorbid with old age (Micheal, & Ramatillah,

2022). Heart failure is a prime example of a life-

threatening condition that requires rapid medical

assistance and special treatment (Ramatillah, D.L,

2021). Heart failure is the inability of the heart to

properly and adequately pump blood throughout the

body (Ramatillah, D.L, 2021). Significant

correlation (p = 0.0001) Favirapir + Clopidogrel +

Ascardia + Amlodipine (Survive = 25.5%).

Remdesivir + Clopidogrel + Ascardia +

Amlodipine (Survive = 21.4%)

4 DISCUSSION

In examining the association between age and blood

pressure in COVID-19 (Laila, D,2021) patients with

comorbid heart disease, it was discovered that many

patients died due to advanced age and were

susceptible to abnormal blood pressure and

additional comorbidities due to precipitating factors

such as decreased organ function. Who do not

perform well when utilizing the Mann-

In the case of patients with a history of co-

morbid diseases being infected with Covid-19, there

is a strong correlation. Patients with a history of co-

morbid diseases are extremely susceptible to Covid-

19 infection due to a weakened immune system and

a decline in the quality of body organ functions

(King, M, 2012).

Several comorbid disorders, such as

hypertension and diabetes, are frequently observed

in COVID-19-infected patients. Diabetes is a set of

metabolic diseases characterized by hyperglycemia

that results from abnormalities in insulin secretion,

insulin action, or both (Vaduganathan, M, 2020)

Diabetes remains a risk factor for morbidity and

death in COVID-19 patients,yet many people with

diabetes who are infected with COVID-19 are

nonetheless able to survive (Micheal, & ramatillah,

2022), as are Covid-19 patients with a history of

hypertension.

hypertension is high blood pressure and is

indicated by systolic blood pressure > 140 mmHg or

diastolic blood pressure > 90 mmHg (Micheal, &

ramatillah, 2022). The risk of hypertension (Zheng,

Y, 2020) for determining the diagnosis of heart

failure patients infected with COVID-19 has

particular handlers including medical supporting

examinations including CT-scans, ECGs, Swab

tests, PCR, X-rays, blood pressure checks, and blood

sampling examinations (Micheal, & ramatillah,

2022).

From the data obtained, it can be said, "In the

provision of pharmacological therapy in treating

heart failure patients infected with Covid19, the

administration of drug combinations is very

calculated to support the patient's recovery. in the

administration of antiviral,

antiplatelet, calcium channel blockers (CCBS) or

calcium antagonists. favipirafivir and remdasivir are

useful as antivirals for patients with Covid19,

favipirafir is a strong selective inhibitor derived from

favipirafir which is a strong selective inhibitor

derived from influenza virus RNA polymarse and

can enter the viral RNA chains(Shereen, M, 2020)

In patients with the group using favipirafir, it

The Relation Between Heart Failure and Severity COVID-19 Disease

203

showed a shorter treatment period while remdasivir

was useful as an antiviral which had benefits as

clinical manifestations of patients infected with

Covid19, therapy using remdesivir was generally

used in patients with severe categories and several

comorbid diseases (Shereen, M, 2020).

The administration of antiplatelet drugs in heart

failure patients functions as blood thinners based on

data obtained by antiplatelet drugs such as

clopidogrel and ascardia, clopidogrel and ascardia

itself are widely prescribed by doctors as

recommended drugs to function to reduce the risk of

heart attack by thinning the blood and preventing

clotting blood (N, 2020).

Most of the patients who have confirmed

infection with COVID-19 patients with comorbid

heart failure generally have a history of hypertension

(Vaduganathan, M, 2020). As a treatment therapy

patients are given pharmacological therapy with a

calcium channel brocker or calcium antagonist drug

class, the hypertension drug commonly used is

amlodiphine, amlodhipine itself has 2 types of doses,

namely amlodhipine 5 mg and amlodhipine 10 mg,

amlodhipine has a mechanism of action by

inhibiting calcium influxes into smooth muscle cells

in blood vessels and myocardium cells, amlodhipine

is also indicated for the treatment of hypertension

and angina, the effect of giving amlodhipine at the

right dose for patients Hypertension can cause a

decrease in supinated and orthostatic blood

pressure(Micheal, & ramatillah, 2022)

There is an relation between cardiovascular and

COVID-19 adverse events, an association between

patients with cardiovascular comorbidities who are

more immune to disease with SARS-CoV-2 and may

face more extreme clinical adverse events as a result

of association with ACE2 articulation in these

encounters contrasted with patients without

cardiovascular comorbidities

5 CONCLUSION

Due to the uncontrolled pandemic, which has

resulted in a large number of people being affected

by the outbreak, the increase of COVID-19 cases

remains of particular concern to all of us. The case of

the elderly who have been exposed to heart failure

and other comorbidities does not prevent the

possibility of COVID-19 infection.

The association between heart failure and

COVID-19 is dependent on age, therapy provided,

comorbidities, and the severity of COVID-19; age

and therapy are significant determinants in success

and recovery. Doctors prescribe the antiviral

medications favipirafir and remdasivir to patients

with a high risk of death. As well as ascardia and

clopidogrel, amlodhipine is used to control blood

pressure in COVID-19-infected heart failure patients

(N, 2020).

Cardiovascular damage with COVID-19 is

associated, in particular, patients with cardiovascular

comorbidities are more susceptible to SARS-CoV-2

contamination and may have more extreme clinical

symptoms, possibly because of the association with

patients with ACE2 articulation in this collection

than patients without cardiovascular comorbidities

(Jayanama, K, 2021).

The results of this study can be used by further

researchers as research material and a research

reference, as well as a consideration for expanding

further exploration, and I hope that future scientists

will have the choice to make this research more

comprehensive.

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