The incidence and impact of atrial fibrillation on hospitalized Coronavirus disease-2019 patients

Haiming Niu; Jianwei Li; Catherine Teng; Xiaojia Lu; Chengyue Jin; Peng Cai; Ao Shi; Xiaoqing Shen; Qiqi Chen; Miaolian Chen; Yong Yuan; Pengyang Li

doi:10.1002/clc.24240

The incidence and impact of atrial fibrillation on hospitalized Coronavirus disease-2019 patients

Clin Cardiol. 2024 Feb;47(2):e24240. doi: 10.1002/clc.24240.

Authors

Haiming Niu¹, Jianwei Li¹, Catherine Teng², Xiaojia Lu³, Chengyue Jin⁴, Peng Cai⁵, Ao Shi⁶, Xiaoqing Shen¹, Qiqi Chen¹, Miaolian Chen¹, Yong Yuan⁷, Pengyang Li⁸

Affiliations

¹ Department of Critical Care Medicine, Zhongshan People's Hospital, Zhongshan, P.R. China.
² Division of Cardiology, Department of Medicine, University of Texas Health Science Center, San Antonio, Texas, USA.
³ Department of Cardiology, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
⁴ Department of Cardiology, the First Affiliated Hospital of Shantou University Medical College, Shantou, China.
⁵ Department of Mathematical Sciences, Worcester Polytechnic Institute, Worcester, Massachusetts, USA.
⁶ Faculty of Medicine, St. George University of London, London, UK.
⁷ Department of Cardiovasculogy, Zhongshan People's Hospital, Zhongshan, P.R. China.
⁸ Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA.

Abstract

Background: Since 2019, Coronavirus disease-2019 (COVID-19) has raised unprecedented global health crisis. The incidence and impact of atrial fibrillation (AF) on patients with COVID-19 remain unclearly defined.

Methods: We conducted a retrospective cohort study using ICD-10 codes to identify patients with a primary diagnosis of COVID-19 with or without AF in National Inpatient Sample Database 2020. We compared the outcome of COVID-19 patients with a concurrent diagnosis of AF with those without.

Hypothesis: AF will adversely affect the prognosis of hospitalized COVID-19 patients.

Results: A total of 211 619 patients with a primary diagnosis of COVID-19 were identified. Among these patients, 31 923 (15.08%) had a secondary diagnosis of AF. Before propensity score matching, COVID-AF cohort was older (75.8 vs. 62.2-year-old, p < .001) and had more men (57.5% vs. 52.0%, p < .001). It is associated with more comorbidities, mainly including diabetes mellitus (43.7% vs. 39.9%, p < .001), hyperlipidemia (54.6% vs. 39.8%, p < .001), chronic kidney disease (34.5% vs. 17.0%, p < .001), coronary artery disease (35.3% vs. 14.4%, p < .001), anemia (27.8% vs. 18.6%, p < .001), and cancer (4.8% vs. 3.4%, p < .001). After performing propensity score match, a total of 31 862 patients were matched within each group. COVID-AF cohort had higher inpatient mortality (22.2% vs. 15.3%, p < .001) and more complications, mainly including cardiac arrest (3.9% vs. 2.3%, p < .001), cardiogenic shock (0.9% vs. 0.3%, p < .001), hemorrhagic stroke (0.4% vs. 0.3%, p = .025), and ischemic stroke (1.3% vs. 0.7%, p < .001). COVID-AF cohort was more costly, with a longer length of stay, and a higher total charge.

Conclusion: AF is common in patients hospitalized for COVID-19, and is associated with poorer in-hospital mortality, immediate complications and increased healthcare resource utilization.

Keywords: COVID-19; atrial fibrillation; in-hospital complication; mortality.

MeSH terms

Atrial Fibrillation* / diagnosis
Atrial Fibrillation* / epidemiology
COVID-19* / complications
COVID-19* / epidemiology
Coronavirus*
Humans
Incidence
Male
Middle Aged
Retrospective Studies