Date of Award


Degree Name

PhD Nursing

Dissertation Committee

Cynthia D. Connelly, PhD, RN, FAAN, Chair; Caroline Etland, PhD, RN, ACHPN, Committee Member; Eileen Fry-Bowers, PhD, JD, RN, CPNP, FAAN, Committee Member


Heart failure, Congestive Heart Failure, Cardiac Biomarkers, Coronavirus 2019, COVID-19, SARS-CoV-2


Background: Heart disease continues to be the leading cause of death among adults in the United States and other industrialized countries. Heart failure (HF) is a form of heart disease and has become an epidemic with complications and medical care costs increasing at an alarming rate. HF affects more than 5.7 million adults in the United States with an incidence between 550,000 to 670,000 annually, primarily affecting females, African Americans, and adults aged 55 years and older. HF is also associated with a high rate of mortality, estimated to increase, with a risk rate of 13%, 32%, and 64% among hospitalized adults at 30-day, 1-year, and 5-year respectively. To date, treatment of HF is disease management including medication management, patient education programs, implantable cardiac devices, and end-of-life care. Since the coronavirus disease 2019 (COVID-19) was declared a pandemic in March 2020 in the U.S., research has shown an increased risk of complications and mortality among adults with HF. Currently, limited information exists about the influence COVID-19 has on preexisting HF among adults aged 18 years and older.

Purpose: The purpose of this study was to investigate the difference in cardiac health assessment biomarkers by COVID-19 status (positive or negative) in adults aged 18 years and older with preexisting HF, within the COVID-19 pandemic environment.

Method: A descriptive-correlational, longitudinal design with repeated measures analysis. Retrospective data were extracted from the electronic health record of patients (N = 400) who received care at an acute care hospital in Nevada during the COVID-19 pandemic between October 1, 2020 to January 31, 2022.

Results: Statistically significant associations were found between COVID-19 status and ethnicity, discharge disposition, gender, and age; COVID-19 status and health assessment cardiac biomarkers (i.e., high-sensitivity C-reactive protein [hs-CRP] and high-sensitivity troponin [hs-TnI]); and cardiac health assessment biomarkers and age. Data indicated elevated hs-CRP levels among participants with HF and concomitant COVID-19. Although hs-CRP was found to be elevated, data indicates hs-CRP levels returned to normal over time.

Implication for Nursing: Nurses have continued to care for patients diagnosed with HF since COVID-19 was declared a pandemic. By knowing the influence of COVID-19 on preexisting HF, nurses are better prepared to identify patient needs, minimize long-term sequelae, and implement interventions resulting in positive patient health care outcomes.

Document Type

Dissertation: Open Access



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