AF and in-hospital mortality in COVID-19 patients

Irum D Kotadia; Maria Dias; Caroline Roney; Richard A Parker; Robert O'Dowling; Neil Bodagh; José-Alonso Lemus-Solis; Daniel O'Hare; Iain Sim; David Newby; Steven Niederer; Jonathan Birns; Peter Sommerville; Ajay Bhalla; Mark O'Neill; Steven E Williams

doi:10.1016/j.hroo.2023.10.004

AF and in-hospital mortality in COVID-19 patients

Heart Rhythm O2. 2023 Oct 16;4(11):700-707. doi: 10.1016/j.hroo.2023.10.004. eCollection 2023 Nov.

Authors

Irum D Kotadia¹, Maria Dias¹, Caroline Roney¹, Richard A Parker², Robert O'Dowling¹, Neil Bodagh¹, José-Alonso Lemus-Solis¹, Daniel O'Hare¹, Iain Sim¹, David Newby², Steven Niederer¹, Jonathan Birns³, Peter Sommerville³, Ajay Bhalla³, Mark O'Neill¹, Steven E Williams^{1

2}

Affiliations

¹ Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.
² Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom.
³ Stroke Medicine, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.

Abstract

Background: There are conflicting data on whether new-onset atrial fibrillation (AF) is independently associated with poor outcomes in COVID-19 patients. This study represents the largest dataset curated by manual chart review comparing clinical outcomes between patients with sinus rhythm, pre-existing AF, and new-onset AF.

Objective: The primary aim of this study was to assess patient outcomes in COVID-19 patients with sinus rhythm, pre-existing AF, and new-onset AF. The secondary aim was to evaluate predictors of new-onset AF in patients with COVID-19 infection.

Methods: This was a single-center retrospective study of patients with a confirmed diagnosis of COVID-19 admitted between March and September 2020. Patient demographic data, medical history, and clinical outcome data were manually collected. Adjusted comparisons were performed following propensity score matching between those with pre-existing or new-onset AF and those without AF.

Results: The study population comprised of 1241 patients. A total of 94 (7.6%) patients had pre-existing AF and 42 (3.4%) patients developed new-onset AF. New-onset AF was associated with increased in-hospital mortality before (odds ratio [OR] 3.58, 95% confidence interval [CI] 1.78-7.06, P < .005) and after (OR 2.80, 95% CI 1.01-7.77, P < .005) propensity score matching compared with the no-AF group. However, pre-existing AF was not independently associated with in-hospital mortality compared with patients with no AF (postmatching OR: 1.13, 95% CI 0.57-2.21, P = .732).

Conclusion: New-onset AF, but not pre-existing AF, was independently associated with elevated mortality in patients hospitalised with COVID-19. This observation highlights the need for careful monitoring of COVID-19 patients with new-onset AF. Further research is needed to explain the mechanistic relationship between new-onset AF and clinical outcomes in COVID-19 patients.

Keywords: Atrial fibrillation; COVID-19; COVID-19 and arrhythmia; COVID-19 and cardiovascular complications; SARS-CoV-2.

Abstract

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