What to Know About Heart Failure and COVID-19

People with certain underlying conditions have been found to be at a higher risk of getting the coronavirus disease (COVID-19), and heart failure is one of them.

It's well known that heart failure puts someone at a higher risk of contracting and becoming severely ill with viral respiratory infections. Even as the prevalence of COVID-19 infections declines with the introduction of the COVID-19 vaccines, people with heart failure and other high risk conditions remain at an elevated risk for infection.

Heart Failure and COVID-19 Risk - Illustration by Theresa Chiechi

Verywell / Theresa Chiechi

Heart Failure and COVID-19 Risk

People with a pre-existing heart problem like heart failure are about 10% to 20% more likely to experience severe illness from COVID-19 compared to people with healthy hearts. They are also more likely to get much sicker and even die because of COVID-19.

Research has shown that people who have a history of heart failure who are hospitalized for COVID-19 are nearly twice as likely to die than those who don't. COVID-19 patients with heart failure had hospital stays averaging about two days longer than those without the condition, and they were twice as likely to require mechanical ventilation.

What Is Heart Failure?

Heart failure refers to the chronic, progressive condition that evolves from damaged or weakened heart muscles. The muscles of the heart are what help it to pump oxygen-rich blood throughout the body. A number of factors can lead to heart failure, including coronary artery disease, which is usually caused by the buildup of fatty deposits, or plaque, in your blood vessels (known as atherosclerosis). As these vessels become narrowed or blocked, the heart muscle that those vessels supply may not receive enough oxygen-rich blood. This, in turn, may cause damage to the heart muscle, which can lead to heart failure.

Your heart will try to compensate for this extra effort it has to put forth at first by growing larger, increasing muscle mass, or pumping faster. These are only temporary fixes, though. Each of these attempts to compensate for decreased pumping and circulatory capacity—also referred to as the ejection fraction and cardiac output—only last for so long until they result in even more damage.

As the ejection fraction, or the amount of blood the heart pumps out to your body with each beat, decreases, so does cardiac output, the amount of blood the heart pumps out over a period of time (usually measured in a minute). Lower cardiac output may mean that your body is receiving less oxygenated blood than it needs, which may lead to a drop in blood pressure and oxygen levels and damage to other organ systems like the kidneys. Eventually, the heart and body just can’t keep up, and the person experiences the fatigue, breathing problems, or other symptoms that usually prompt a trip to the healthcare provider.

How COVID-19 Affects Heart Failure

COVID-19 can exacerbate heart failure in a few different ways:

  • COVID-19 infections cause inflammation and the release of inflammatory cells and tiny proteins in the immune system called cytokines. This storm of inflammatory cells may cause damage to the heart. In cases of people with heart failure, it may make existing heart damage even worse.
  • The virus may also directly injure the heart. Additionally, when someone becomes significantly ill fighting a virus such as the coronavirus, this may be more taxing to the heart and cause the heart to work harder. If the heart is already not functioning as well as it should be, it may have trouble keeping up with the increased demands.
  • The novel coronavirus is attracted to angiotensin converting enzyme-2 (ACE2) receptors in particular. There are ACE2 receptors in the heart and vasculature. The ACE2 receptor is where the virus enters cells, so this is a reason why the heart is often affected with COVID-19.

The inflammation and increased production of cytokines as a result of COVID-19 causes blood to become thicker and clot easier. Blood clots can create even more problems for people with heart failure because they can further impede blood flow.

Complications of Heart Failure and COVID-19

People with heart failure are at a greater risk of becoming severely ill with COVID-19. One study found that among patients who were hospitalized with a COVID-19 infection, there was a 50% mortality rate among those with pre-existing heart failure compared with a mortality rate of 10% in individuals without heart failure.

Treatment for COVID-19 can also lead to serious complications for people with heart failure due to several contributing factors:

  • Breathing can be difficult for people with heart failure even without a COVID-19 infection. Fluid can accumulate in the body, particularly in the lungs, since blood that can't be pumped throughout the body causes a backup. This can further reduce the much-needed oxygen supply in people with heart failure. Additionally, COVID-19 usually results in pneumonia and decreased movement of oxygen across the cells in the lung to the bloodstream.
  • As COVID-19 and heart failure create difficulty for the body to breathe and pump blood, a person's chances of requiring mechanical ventilation increase. This may seem like the fix. However, especially for people with heart failure, there has been evidence that the high pressure required to support the breathing of people with COVID-19 on mechanical ventilation can further increase pressure in the pulmonary vessels. This creates even greater strain—and damage—to the heart.
  • Severe COVID-19 infection has also been known to cause kidney damage, which can further increase the workload of the heart.

In one study from China, researchers found that about half of all people who died from COVID-19 had increased troponin levels. Troponin is released when heart tissue becomes damaged, so this illustrates the toll that COVID-19 takes on the heart. For people whose hearts are already weakened by heart failure, this additional injury can prove deadly.

Even people without heart failure before a COVID-19 infection may find themselves with heart failure after they have survived the infection.

Heart Failure Treatments and COVID-19

The key to managing heart failure is adhering to a treatment strategy that includes medications and lifestyle changes. In severe cases, implants or surgeries may be required. Some common prescription medications used to treat heart failure include:

  • Angiotensin-converting enzyme inhibitors like captopril, lisinopril, enalapril, and ramipril
  • Angiotensin receptor blockers (ARB) like valsartan and losartan
  • Beta-blockers like carvedilol, metoprolol succinate, and bisoprolol
  • Angiotensin receptor neprilysin inhibitor (ARNi)
  • Aldosterone antagonists like spironolactone
  • Isosorbide dinitrate and hydralazine
  • Digoxin
  • Ivabradine
  • Diuretics like furosemide and torsemide
  • SGLT2 inhibitors like empagliflozin

Many of these medications carry a risk of side effects like dizziness, low blood pressure, shortness of breath, and difficulty breathing. These symptoms can be exacerbated by COVID-19 or make a coronavirus infection feel worse.

People with heart failure should stick to the medication regimen prescribed by their healthcare provider—even if they have COVID-19. Call your practitioner before making any medication changes on your own.

A Word From Verywell

Heart failure can put you at higher risk of more severe cases of COVID-19. Everyone should take the necessary precautions to protect themselves from the coronavirus, but it's even more important for people with heart failure to do so. It's recommended that persons with heart failure get vaccinated against COVID-19, which can offer an extra layer of protection. Reach out to your local vaccination center to learn more.

COVID-19 has the potential to worsen heart failure. Stay healthy and keep track of your condition by maintaining regular contact with your healthcare provider and sticking to your treatment regimen. Avoid becoming infected by practicing social distancing and mask wearing.

The information in this article is current as of the date listed. As new research becomes available, we’ll update this article. For the latest on COVID-19, visit our coronavirus news page.

Frequently Asked Questions

Is COVID-19 More Dangerous for People With Heart Failure?

Yes. If you have heart failure, you are more susceptible to viral respiratory infections. Since COVID-19 is caused by a respiratory virus, you should take precautions to avoid becoming infected with the virus.

Should I Continue to Go to My Regular Appointments?

Yes. It is incredibly important for people with heart failure to stay in regular contact with their cardiologist. You learn to recognize symptoms of worsening heart failure and know what to do if they happen. Your healthcare team can monitor your symptoms possibly by telemedicine before you require a visit to the hospital.

You should stay current on all testing, treatments, and medications for heart failure. While visiting a healthcare provider's office does pose some risk of contracting COVID-19, there are a number of steps you can take to minimize that risk, including:

  • Social distancing
  • Wearing a mask
  • Frequently cleaning your hands with soap or hand sanitizers
  • Using telehealth services when possible

Should I Keep Taking All of My Medications?

Absolutely. You should never stop any cardiac medications unless directed to do so by your healthcare provider. If you are concerned about infection risk or side effects, call your practitioner before stopping your medication or changing doses.

If I Get COVID-19, Will I Become Sicker Than Others?

Probably. While researchers are still collecting more data, early studies have shown that people with pre-existing heart conditions like heart failure get sicker than people without those conditions if they become infected with COVID-19. Be sure to take safety precautions to protect yourself from the virus.

Is It Safe for Me to Get One of the COVID-19 Vaccines?

Yes. Not only is it safe for people with heart failure to get one of the vaccines approved for preventing COVID-19, it's highly recommended. A number of medical organizations support COVID-19 vaccination for patients with heart conditions, including heart failure.

How to Stay Safe

Hospitalization for a heart failure exacerbation could be especially tricky in the pandemic, particularly in areas where health systems are already strained. There are a number of ways you can keep your heart failure in check and avoid getting COVID-19:

  • Make sure you are up to date on all of your vaccinations, including influenza and pneumonia vaccines.
  • Ask your healthcare provider if you can stay in touch with them through virtual or telehealth appointments to limit your exposure.
  • Discuss the necessity of certain health screenings or nonessential procedures with your practitioner.
  • Make sure you keep a list of your current medications and doses with you at all times.
  • Keep at least a 30-day supply of your medications on hand.
  • Stay active and find ways to reduce stress while keeping social distancing recommendations in mind.
  • Wear a mask.
  • Don't smoke or vape.
  • Avoid places and situations where you may be exposed to a large number of people.
  • Practice frequent and thorough hand washing.

If your heart failure symptoms worsen significantly, call 911 or go to the emergency department.

11 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Rachael Zimlich, BSN, RN
 Rachael is a freelance healthcare writer and critical care nurse based near Cleveland, Ohio.