ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. Cardiac Rhythmology
Outcomes in Heart Failure Patients with Third-Degree Heart Block during COVID-19
Benjamin Joseph Kash 1
Ethan Wahle 1
Eli Blaney 1
Saif Zurob 1
Amjad Kabach 1,2
Ali Bin Abdul Jabbar 1,2
1. Creighton University School of Medicine, Omaha, United States
2. CHI Health Creighton University Medical Center, Omaha, United States
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Abstract
Objective: Heart failure is a common sequela of third-degree heart block. This study examined trends in mortality and utilization of medical resources before and during the COVID-19 pandemic in these patients. We also sought to investigate these 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 from 2017–2022 were selected from the Healthcare Cost and Utilization Project National Inpatient Sample (NIS). 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 linear regression. Results: There were 22,900 pre-pandemic (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 presence of chronic pulmonary disease (OR: 1.79, 95% 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.
Summary
Keywords
COVID-19 pandemic3, Heart failure1, in-hospitalmortality4, length of stay5, third-degree heart block2, total hospital charges6
Received
08 September 2025
Accepted
10 February 2026
Copyright
© 2026 Kash, Wahle, Blaney, Zurob, Kabach and Abdul Jabbar. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Benjamin Joseph Kash; Ethan Wahle; Eli Blaney; Saif Zurob; Amjad Kabach; Ali Bin Abdul Jabbar
Disclaimer
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.