Atrial fibrillation is an independent predictor for in-hospital mortality in patients admitted with SARS-CoV-2 infection

Mountantonakis, Stavros; Saleh, Moussa; Fishbein, Joanna; Gandomi, Amir H.; Lesser, Martin; Chelico, John; Gabriels, James; Qiu, Michael; Epstein, Laurence M.

doi:10.1016/j.hrthm.2021.01.018

Cited by 91 publications

(129 citation statements)

References 29 publications

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“…Of the 783 studies identified from the literature search (216 on Pubmed and 567 on EMBASE), 31 studies were selected according to the inclusion and exclusion criteria and included in the analysis [ 3 , 10 , 11 , 12 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 ] ( Figure S1 in Supplementary Materials ), with a total of 187,716 COVID-19 patients. Baseline characteristics of the studies included are reported in Table 1 .…”

Section: Resultsmentioning

confidence: 99%

“…Thirteen studies were held in Europe [ 10 , 11 , 25 , 29 , 31 , 33 , 37 , 39 , 42 , 43 , 44 , 47 , 50 ], nine in North America [ 3 , 28 , 30 , 32 , 41 , 45 , 46 , 49 , 51 ], four in Asia [ 26 , 34 , 35 , 48 ], and five in other geographical locations, including one multinational study [ 12 , 27 , 36 , 38 , 40 ]. Twenty-five studies were observational retrospective [ 3 , 10 , 12 , 26 , 28 , 30 , 31 , 32 , 34 , 35 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 ], four were based on prospective observational analysis of single center cohorts [ 11 , …”

Section: Resultsmentioning

confidence: 99%

“…Of the studies, 14 were included in the analysis for all-cause mortality according to AF status (12 reported in-hospital death [ 3 , 10 , 12 , 25 , 29 , 30 , 37 , 40 , 41 , 42 , 43 , 45 ] and two described 30-day mortality [ 32 , 50 ]). Nine studies included patients with new onset AF [ 10 , 29 , 36 , 37 , 40 , 41 , 42 , 45 , 51 ]. To improve the reliability of our estimates, after careful evaluation of the definitions of AF used and of the data reported, for two studies [ 37 , 51 ], we decided to compute only new onset AF in the main analysis about prevalence.…”

Section: Resultsmentioning

confidence: 99%

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Prevalence and Impact of Atrial Fibrillation in Hospitalized Patients with COVID-19: A Systematic Review and Meta-Analysis

Romiti

Corica

Lip

et al. 2021

JCM

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Background: In patients with COVID-19, cardiovascular complications are common and associated with poor prognosis. Among these, an association between atrial fibrillation (AF) and COVID-19 has been described; however, the extent of this relationship is unclear. The aim of this study is to investigate the epidemiology of AF in COVID-19 patients and its impact on all-cause mortality. Methods: A systematic review and meta-analysis were performed and reported according to PRISMA guidelines, and a protocol for this study was registered on PROSPERO (CRD42021227950). PubMed and EMBASE were systematically searched for relevant studies. A random-effects model was used to estimate pooled odds ratios (OR) and 95% confidence intervals (CI). Results: Overall, 31 studies were included in the analysis, with a total number of 187,716 COVID-19 patients. The prevalence of AF was found to be as high as 8% of patients with COVID-19 (95% CI: 6.3–10.2%, 95% prediction intervals (PI): 2.0–27.1%), with a high degree of heterogeneity between studies; a multiple meta-regression model including geographical location, age, hypertension, and diabetes showed that these factors accounted for more than a third of the heterogeneity. AF COVID-19 patients were less likely to be female but more likely older, hypertensive, and with a critical status than those without AF. Patients with AF showed a significant increase in the risk of all-cause mortality (OR: 3.97, 95% CI: 2.76–5.71), with a high degree of heterogeneity. A sensitivity analysis focusing on new-onset AF showed the consistency of these results. Conclusions: Among COVID-19 patients, AF is found in 8% of patients. AF COVID-19 patients are older, more hypertensive, and more likely to have a critical status. In COVID-19 patients, AF is associated with a 4-fold higher risk of death. Further studies are needed to define the best treatment strategies to improve the prognosis of AF COVID-19 patients.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Prevalence and Impact of Atrial Fibrillation in Hospitalized Patients with COVID-19: A Systematic Review and Meta-Analysis

Romiti

Corica

Lip

et al. 2021

JCM

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“…AF per se seems to be associated with a worse COVID-19 prognosis [8][9][10], and uncertainty exists about the effects of chronic OACs on AF patients who develop the infection, as the available evidence is inconclusive and, often, conflicting [11][12][13][14]. Clarifying this issue would be of great relevance to improve the clinical management of people with AF and COVID-19.…”

Section: Introductionmentioning

confidence: 99%

COVID-19 and Atrial Fibrillation in Older Patients: Does Oral Anticoagulant Therapy Provide a Survival Benefit?—An Insight from the GeroCovid Registry

Fumagalli

Trevisan

Signore³

et al. 2021

Thromb Haemost

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Introduction. Atrial fibrillation (AF), the most frequent arrhythmia of older patients, associates with serious thrombo-embolic complications and high mortality. COVID-19 severely affects aged subjects, determining an important prothrombotic status. Aim of this study was to evaluate mortality-related factors in older AF patients with COVID-19. Methods. Between March and June 2020, we enrolled >=60 years in-hospital COVID-19 patients (N=806) in GeroCovid, a multicenter observational study promoted by the Italian Society of Gerontology and Geriatric Medicine. Results. The prevalence of AF was 21.8%. In-hospital mortality was higher in the AF group (36.9 vs. 27.5%, p=0.015). At admission, 51.7%, 10.2% and 38.1% of AF cases were taking, respectively, oral anticoagulants (OACs), antiplatelet agents and no antithrombotic therapy. During hospitalization, 51% patients switched to low-molecular weight heparins. AF patients who survived were younger (81±8 vs. 84±7 years; p=0.002) and had a lower CHA2DS2-VASc score (3.9±1.6 vs. 4.4±1.3; p=0.02) than those who died. OACs use before (63.1% vs. 32.3%; p<0.001) and during hospitalization (34.0% vs. 12.7%; p=0.002) was higher among survivors. At multivariable analysis, lower age, higher self-sufficiency, less severe initial COVID-19 presentation, and the use of Vitamin K antagonists (OR=0.16, 95%CI: 0.03-0.84) or DOACs (OR=0.22, 95%CI: 0.08-0.56) at admission, or the persistence of OAC during hospitalization (OR=0.05, 95%CI: 0.01-0.24), were associated with a lower chance of in-hospital death. Conclusions. AF is a prevalent and severe condition in older COVID-19 patients. Advanced age, dependency and relevant clinical manifestations of disease characterized a worse prognosis. Pre-admission and in-hospital anticoagulant therapy were positively associated with survival.

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“…Mountantonakis et al evaluated the incremental effect of new-onset atrial fibrillation with a history of atrial fibrillation on in-hospital mortality and found an aRR of 1.18 [95% CI 1.04 – 1.33]. 41 Whether pre-existing atrial fibrillation should be viewed as an independent risk factor of in-hospital mortality or is primarily a proxy for underlying frailty in the elderly remains to be explored.…”

Section: Discussionmentioning

confidence: 99%

Clinical presentation, disease course and outcome of COVID-19 in hospitalized patients with and without pre-existing cardiac disease – a cohort study across eighteen countries

Linschoten

Uijl

Schut

et al. 2021

Preprint

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Aims Patients with cardiac disease are considered high risk for poor outcomes following hospitalization with COVID-19. The primary aim of this study was to evaluate heterogeneity in associations between various heart disease subtypes and in-hospital mortality. Method and results We used data from the CAPACITY-COVID registry and LEOSS study. Multivariable modified Poisson regression models were fitted to assess the association between different types of pre-existent heart disease and in-hospital mortality. 10,481 patients with COVID-19 were included (22.4% aged 66-75 years; 38.7% female) of which 30.5% had a history of cardiac disease. Patients with heart disease were older, predominantly male and more likely to have other comorbid conditions when compared to those without. COVID-19 symptoms at presentation did not differ between these groups. Mortality was higher in patients with cardiac disease (30.3%; n=968 versus 15.7%; n=1143). However, following multivariable adjustment this difference was not significant (adjusted risk ratio (aRR) 1.06 [95% CI 0.98-1.15, p-value 0.13]). Associations with in-hospital mortality by heart disease subtypes differed considerably, with the strongest association for NYHA III/IV heart failure (aRR 1.43 [95% CI 1.22-1.68, p-value <0.001]) and atrial fibrillation (aRR 1.14 [95% CI 1.04-1.24, p-value 0.01]). None of the other heart disease subtypes, including ischemic heart disease, remained significant after multivariable adjustment. Conclusion There is considerable heterogeneity in the strength of association between heart disease subtypes and in-hospital mortality. Of all patients with heart disease, those with severe heart failure are at greatest risk of death when hospitalized with COVID-19.

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Atrial fibrillation is an independent predictor for in-hospital mortality in patients admitted with SARS-CoV-2 infection

Cited by 91 publications

References 29 publications

Prevalence and Impact of Atrial Fibrillation in Hospitalized Patients with COVID-19: A Systematic Review and Meta-Analysis

Prevalence and Impact of Atrial Fibrillation in Hospitalized Patients with COVID-19: A Systematic Review and Meta-Analysis

COVID-19 and Atrial Fibrillation in Older Patients: Does Oral Anticoagulant Therapy Provide a Survival Benefit?—An Insight from the GeroCovid Registry

Clinical presentation, disease course and outcome of COVID-19 in hospitalized patients with and without pre-existing cardiac disease – a cohort study across eighteen countries

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