Heart failure during the COVID‐19 pandemic: clinical, diagnostic, management, and organizational dilemmas

Alberto Palazzuoli*, Marco Metra, Sean P. Collins, Marianna Adamo, Andrew P. Ambrosy, Laura E. Antohi, Tuvia Ben Gal, Dimitrios Farmakis, Finn Gustafsson, Loreena Hill, Yuri Lopatin, Francesco Tramonte, Alexander Lyon, Josep Masip, Oscar Miro, Brenda Moura, Wilfried Mullens, Razvan I. Radu, Magdy Abdelhamid, Stefan AnkerOvidiu Chioncel

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

11 Citations (Scopus)
44 Downloads (Pure)


The coronavirus 2019 (COVID‐19) infection pandemic has affected the care of patients with heart failure (HF). Several consensus documents describe the appropriate diagnostic algorithm and treatment approach for patients with HF and associated COVID‐19 infection. However, few questions about the mechanisms by which COVID can exacerbate HF in patients with high‐risk (Stage B) or symptomatic HF (Stage C) remain unanswered. Therefore, the type of HF occurring during infection is poorly investigated. The diagnostic differentiation and management should be focused on the identification of the HF phenotype, underlying causes, and subsequent tailored therapy. In this framework, the relationship existing between COVID and onset of acute decompensated HF, isolated right HF, and cardiogenic shock is questioned, and the specific management is mainly based on local hospital organization rather than a standardized model. Similarly, some specific populations such as advanced HF, heart transplant, patients with left ventricular assist device (LVAD), or valve disease remain under investigated. In this systematic review, we examine recent advances regarding the relationships between HF and COVID‐19 pandemic with respect to epidemiology, pathogenetic mechanisms, and differential diagnosis. Also, according to the recent HF guidelines definition, we highlight different clinical profile identification, pointing out the main concerns in understudied HF populations.
Original languageEnglish
Pages (from-to)3713-3736
Number of pages24
JournalESC Heart Failure
Issue number6
Early online date16 Sept 2022
Publication statusPublished - Dec 2022


  • Review
  • Reviews
  • COVID‐19
  • Heart failure
  • Diagnostic differentiation
  • Management


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