What to Know About Heart Failure and COVID-19

People with certain underlying medical conditions are 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 though COVID-19 vaccines reduce the risk of COVID-19 infections, people with heart failure and other high-risk conditions are still at increased risk for infection.

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.

Nearly 1 in 3 adults with a history of heart failure died during hospitalization for COVID-19. This is almost double the in-hospital mortality for adults without heart failure.

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.

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 (ACE) inhibitors like Capoten (captopril), Zestril (lisinopril), Vaseretic (enalapril), and Altace (ramipril)
• Angiotensin receptor blockers (ARBs) like Diovan (valsartan) and Cozaar (losartan)
• Beta-blockers like Coreg (carvedilol), Toprol-XL (metoprolol succinate), and Ziac (bisoprolol)
• Neprilysin inhibitors like Entresto (sacubitril and valsartan)
• Mineralcorticoid receptor antagonists (MRAs) like Aldactone (spironolactone)
• Vasodilators like BiDil (hydralazine hydrochloride and isosorbide dinitrate)
• Antiarrhythmics like Lanoxin (digoxin) 
• I(f) channel blockers like Corlanor (ivabradine)
• Diuretics like Lasix (furosemide) and Demadex (torsemide)

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.

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.

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.