Atrial fibrillation in patients with COVID-19. Usefulness of the CHA2DS2-VASc score: an analysis of the international HOPE COVID-19 registry

Uribarri, Aitor; Núñez‐Gil, Iván J.; Alonso, Álvaro; Arroyo-Espliguero, Ramón; Eid, Charbel Maroun; Romero, Rodolfo; Becerra-Muñoz, Víctor Manuel; Feltes, Gisela; Molina, María; García-Aguado, Marcos; Cerrato, Enrico; Capel-Astrua, Thamar; Alfonso-Rodríguez, Emilio; Castro-Mejía, Alex F.; Raposeiras‐Roubín, Sergio; Espejo, Carolina; Pérez-Solé, Nerea; Bardajı́, Alfredo; Marı́n, Francisco; Fabregat-Andrés, Óscar; D’Ascenzo, Fabrizio; Santoro, Francesco; Akın, İbrahim; Estrada, Vicente; Fernández‐Ortíz, Antonio; Macaya, Carlos

doi:10.1016/j.rec.2020.12.009

Cited by 11 publications

(19 citation statements)

References 21 publications

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“…Due to a high prevalence of broad spectrum of comorbidities in patients with AF/AFL (e.g., hypertension, COPD, CAD) the distinction needs to be made between the impact of AF/AFL and the impact of other chronic diseases on in-hospital mortality. To date, in spite of the burden of comorbidities in patients with AF/AFL, many studies included in this metaanalysis confirmed that AF/AFL is an independent negative prognostic factor in patient with COVID-19 [23,24,29,32,33,36,37,40,41]. To confirm this finding, AF was associated with higher in-hospital mortality mainly in patients with a low or intermediate CHA 2 DS 2 -VASc score [15], suggesting that the existence of AF/AFL is not only the cumulative measure of risk due to other chronic diseases, but a novel prognostic factor.…”

Section: Mortality In New-onset Vs Pre-existing Af/aflmentioning

confidence: 62%

“…Interestingly, no such difference was visible for C-reactive protein, white blood cell count, lymphocytes or neutrophils. In another study by Uribarri et al [41] patients with AF have a significantly higher incidence of HF, but lower incidence of respiratory insufficiency, high flow nasal cannula, both with noninvasive and invasive mechanical ventilation. This suggests that AF/AFL may exert its detrimental effects (reflected by the necessity of therapy in ICU) through myocardial injury rather than only passively reflecting the lung pathology and hyperinflammatory state.…”

Section: Icu Admissionmentioning

confidence: 91%

“…A total of 1,012 articles were identified from the Medline (PubMed), Embase, Cochrane library, and the manual search as described above. Ultimately, nineteen studies [23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41] published from 2020 to 2021 which included 33,296 patients in the meta-analysis (Fig. 1).…”

Section: Characteristics Of Studies Included In the Meta-analysismentioning

confidence: 99%

“…Bleeding complications occurred 3.5 times more often in the AF/AFL group compared to the non-AF/AFL group, based on 4 studies [26,35,37,41]. Interestingly, one study reported that in patients with AF, a percentage of those treated with appropriate doses of anticoagulants was low (57%) [41]. The remaining individuals were either treated with a prophylactic dose only (25.7%) or did not receive any anticoagulant treatment (17.3%).…”

Section: Individual Complicationsmentioning

confidence: 99%

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Outcomes and mortality associated with atrial arrhythmias among patients hospitalized with COVID-19: A systematic review and meta-analysis

Szarpak

Filipiak‬²,

Skwarek

et al. 2022

Cardiol J.

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Section: Mortality In New-onset Vs Pre-existing Af/aflmentioning

confidence: 62%

Section: Icu Admissionmentioning

confidence: 91%

Section: Characteristics Of Studies Included In the Meta-analysismentioning

confidence: 99%

Section: Individual Complicationsmentioning

confidence: 99%

See 2 more Smart Citations

Outcomes and mortality associated with atrial arrhythmias among patients hospitalized with COVID-19: A systematic review and meta-analysis

Szarpak

Filipiak‬²,

Skwarek

et al. 2022

Cardiol J.

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show abstract

“…Recent studies found that CHA2DS2-VASc score is useful to predict in-hospital mortality but does not predict embolic risk in COVID-19 patients. Therefore, the results should be read and used with caution in the pandemic situation [ 23 , 24 ].…”

Section: Discussionmentioning

confidence: 99%

CHA2DS2-VASc Score for Major Adverse Cardiovascular Events Stratification in Patients with Pneumonia with and without Atrial Fibrillation

Wang

Lin

et al. 2021

JCM

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Background: Recent studies have shown an association between CHA2DS2-VASc (congestive heart failure, hypertension, age ≥ 75 years, diabetes mellitus, stroke or transient ischemic attack (TIA), vascular disease, age 65 to 74 years, sex category) score and outcome of acute myocardial infarction, stroke, and chest pain. As pneumonia can affect the cardiovascular system, this study aimed to investigate the performance of the CHA2DS2-VASc score for major adverse cardiovascular events (MACEs) risk stratification in patients with pneumonia. Methods: A retrospective population-based cohort study including 61,843 patients with pneumonia. These patients were divided into two cohorts that were stratified based on the presence or absence of underlying atrial fibrillation (AF). We calculated the CHA2DS2-VASc score and incidence density rates of MACEs in each cohort. Cox regression was conducted to calculate hazard ratio of MACEs in pneumonia patients. The diagnostic performance of CHA2DS2-VASc with regard to MACEs was tested using the receiver operator characteristic curve. Results: Pneumonia patients with higher CHA2DS2-VASc score were more likely develop MACEs in both the AF and non-AF groups. In the AF group, the areas under the curve (AUC), sensitivity, and specificity were 0.824 (0.7773–0.8708), 0.7, and 0.84 respectively. In the non-AF group, the AUC, sensitivity, and specificity were 0.8185 (0.8152–0.8217), 0.75, and 0.83 respectively. Conclusions: The CHA2DS2-VASc score showed good performance in the prediction of MACE in patients with pneumonia.

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Incidence of new-onset atrial fibrillation in COVID-19 is associated with increased epicardial adipose tissue

Slipczuk

Castagna

Schonberger

et al. 2021

J Interv Card Electrophysiol

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Purpose Coronary artery calcium (CAC) and epicardial adipose tissue (EAT) can predict AF in the general population. We aimed to determine if CAC and EAT measured by computed tomographic (CT) scanning can predict new-onset AF in patients admitted with COVID-19 disease. Methods We performed a retrospective, post hoc analysis of all patients admitted to Montefiore Medical Center with a confirmed COVID-19 diagnosis from March 1st to June 23rd, 2020, who had a non-contrast CT of the chest within 5 years prior to admission. We determined ordinal CAC scores and quantified the EAT volume and examined their relationship with inpatient mortality. Results A total of 379 patients were analyzed. There were 16 events of new-onset AF (4.22%). Patients who developed AF during the index admission were more likely to be male (75 vs 47%, p < 0.001) and had higher EAT (129.5 [76.3–197.3] vs 91.0 [60.0–129.0] ml, p = 0.049). There were no differences on age (68 [56–71] vs 68 [58–76] years; p = 0.712), BMI (28.5 [25.3–30.8] vs 26.9 [23.1–31.8] kg/m 2 ; p = 0.283), ordinal CAC score (3 [1–6] vs 2 [0–4]; p = 0.482), or prevalence of diabetes (56.3 vs 60.1%; p = 0.761), hypertension (75.0 vs 87.3%, p = 0.153), or coronary artery disease (50.0 vs 39.4%, p = 0.396). Patients with new-onset AF had worse clinical outcomes (death/intubation/vasopressors) (87.5 vs 44.1%; p = 0.001). Conclusion Increased EAT measured by non-contrast chest CT identifies patients hospitalized with COVID-19 at higher risk of developing new-onset AF. Patients with new-onset AF have worse clinical outcomes.

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Atrial fibrillation in patients with COVID-19. Usefulness of the CHA2DS2-VASc score: an analysis of the international HOPE COVID-19 registry

Cited by 11 publications

References 21 publications

Outcomes and mortality associated with atrial arrhythmias among patients hospitalized with COVID-19: A systematic review and meta-analysis

Outcomes and mortality associated with atrial arrhythmias among patients hospitalized with COVID-19: A systematic review and meta-analysis

CHA2DS2-VASc Score for Major Adverse Cardiovascular Events Stratification in Patients with Pneumonia with and without Atrial Fibrillation

Incidence of new-onset atrial fibrillation in COVID-19 is associated with increased epicardial adipose tissue

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