Cardiovascular

Impact of SARS-CoV-2 infection and viral burden on outcomes in acute decompensated heart failure.

Nashtar M, Sehovic H, et al. • BMC infectious diseases • 2026

PubMed 42768323 DOI 10.1186/s12879-026-14407-y

TL;DR

Among patients hospitalized with acute decompensated heart failure, concomitant SARS-CoV-2 infection was associated with substantially worse in-hospital outcomes and greater healthcare resource utilization, with lower cycle threshold values further associated with higher in-hospital mortality and longer hospital stay.

Key Findings

Results

SARS-CoV-2 infection was confirmed in 12.3% of adults hospitalized with acute decompensated heart failure over the study period.

Retrospective cohort study of 2,002 adults hospitalized with ADHF at a tertiary academic center between March 2020 and December 2024.
246 of 2,002 patients (12.3%) had confirmed SARS-CoV-2 infection during the index hospitalization.
Infection was confirmed by reverse transcription quantitative polymerase chain reaction (RT-qPCR).

Results

In-hospital mortality was significantly higher in SARS-CoV-2-infected ADHF patients compared to uninfected patients.

In-hospital mortality was 32.5% among infected patients versus 20.6% among uninfected patients (p ≤ 0.002).
After multivariable adjustment, SARS-CoV-2 infection remained independently associated with in-hospital mortality (aOR 2.63, p = 0.0002).
Multivariable regression models were adjusted for clinically relevant covariates.

Results

SARS-CoV-2 infection was independently associated with higher rates of ICU admission in ADHF patients.

ICU admission occurred in 61.4% of infected patients versus 50.7% of uninfected patients (p ≤ 0.002).
After multivariable adjustment, infection remained associated with ICU admission (aOR 1.79, p = 0.0027).

Results

SARS-CoV-2 infection was independently associated with higher rates of invasive mechanical ventilation in ADHF patients.

Invasive mechanical ventilation was required in 6.5% of infected patients versus 2.4% of uninfected patients (p ≤ 0.002).
After multivariable adjustment, infection remained associated with invasive mechanical ventilation (aOR 2.84, p = 0.0017).

Results

SARS-CoV-2 infection was associated with substantially longer hospital and ICU lengths of stay in ADHF patients.

Infection was associated with longer hospital stay (adjusted β +9.23 days, p < 0.0001).
Infection was also associated with longer ICU stay (adjusted β +7.85 days, p = 0.0017).
These associations were assessed as resource-utilization outcomes using multivariable regression.

Results

Among infected ADHF patients, lower median cycle threshold (Ct) values were associated with higher in-hospital mortality.

Lower median Ct values were associated with higher in-hospital mortality (aOR 0.89 per Ct unit, p = 0.0338), indicating that each unit increase in Ct was associated with an 11% lower odds of death.
Ct values were analyzed as surrogate markers of viral burden among the 246 infected patients.
The authors note that 'Ct values are imperfect surrogate markers of viral burden' and that these associations 'should be considered hypothesis-generating and require prospective validation.'

Results

Among infected ADHF patients, lower minimum Ct values were associated with longer hospital stay.

Lower minimum Ct values were associated with longer hospital stay (adjusted β -0.44 days per Ct unit, p = 0.0359), meaning higher viral burden was associated with extended hospitalization.
This association was identified through multivariable analysis within the infected patient subgroup.
The authors caution that this finding requires prospective validation.

What This Means

This research suggests that heart failure patients who are hospitalized and simultaneously infected with SARS-CoV-2 face dramatically worse outcomes than those without COVID-19. In a study of over 2,000 adults admitted to a hospital with acute heart failure between 2020 and 2024, about 1 in 8 also had a confirmed COVID-19 infection. These co-infected patients were more than twice as likely to die during their hospitalization, more likely to need intensive care or breathing machines, and spent on average over 9 more days in the hospital and nearly 8 more days in the ICU compared to heart failure patients without COVID-19. The study also examined whether the amount of virus a patient carried — estimated using a lab measurement called the cycle threshold (Ct) value, where lower values indicate more virus — was linked to worse outcomes within the COVID-positive group. The findings suggest that patients with higher viral loads (lower Ct values) had higher odds of dying in the hospital and longer hospital stays. However, the authors emphasize that Ct values are imperfect measures of viral burden and that these specific findings should be considered preliminary until confirmed by future studies designed specifically to test this question. This research suggests that the combination of heart failure and COVID-19 is a particularly dangerous pairing, placing patients at significantly elevated risk and placing greater demands on hospital resources. This highlights the clinical importance of COVID-19 testing in hospitalized heart failure patients and points to potential value in tracking viral burden as a prognostic tool, pending further research.

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Citation

Nashtar M, Sehovic H, Salemdawod M, Garipoglu G, &#xd6;demis B, Tzalavras A, et al.. (2026). Impact of SARS-CoV-2 infection and viral burden on outcomes in acute decompensated heart failure.. BMC infectious diseases. https://doi.org/10.1186/s12879-026-14407-y

Key Findings

What This Means

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