Outcomes and mortality associated with atrial arrhythmias among patients hospitalized with COVID‐19

Abstract

Introduction The impact of atrial arrhythmias on coronavirus disease 2019 (COVID‐19)‐associated outcomes are unclear. We sought to identify prevalence, risk factors and outcomes associated with atrial arrhythmias among patients hospitalized with COVID‐19. Methods An observational cohort study of 1053 patients with severe acute respiratory syndrome coronavirus 2 infection admitted to a quaternary care hospital and a community hospital was conducted. Data from electrocardiographic and telemetry were collected to identify atrial fibrillation (AF) or atrial flutter/tachycardia (AFL). The association between atrial arrhythmias and 30‐day mortality was assessed with multivariable analysis. Results Mean age of patients was 62 ± 17 years and 62% were men. Atrial arrhythmias were identified in 166 (15.8%) patients, with AF in 154 (14.6%) patients and AFL in 40 (3.8%) patients. Newly detected atrial arrhythmias occurred in 101 (9.6%) patients. Age, male sex, prior AF, renal disease, and hypoxia on presentation were independently associated with AF/AFL occurrence. Compared with patients without AF/AFL, patients with AF/AFL had significantly higher levels of troponin, B‐type natriuretic peptide, C‐reactive protein, ferritin and d ‐dimer. Mortality was significantly higher among patients with AF/AFL (39.2%) compared to patients without (13.4%; p < .001). After adjustment for age and co‐morbidities, AF/AFL (adjusted odds ratio [OR]: 1.93; p = .007) and newly detected AF/AFL (adjusted OR: 2.87; p < .001) were independently associated with 30‐day mortality. Conclusion Atrial arrhythmias are common among patients hospitalized with COVID‐19. The presence of AF/AFL tracked with markers of inflammation and cardiac injury. Atrial arrhythmias were independently associated with increased mortality.

Frequency of Atrial Arrhythmia in Hospitalized Patients With COVID-19

“…In a recent study of 700 hospitalized patients, 25 (3.6%) individuals were diagnosed with new onset AF 9 . In a larger population of patients from New York City, AA was also detected in 15.8% of the patients, 9.6% of which were newly diagnosed 10 . This rate is higher than the current study and it is possibly due to the higher percentage of white patients in their cohort.…”

Meta-Analysis of Atrial Fibrillation in Patients With COVID-19

“…Nine hundred and sixteen potentially relevant studies were screened according to the inclusion and exclusion criteria. Finally, 23 studies with 108,745 COVID-19 patients 1 , 2 , 3 , 4 , 5 , 6 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 were eligibly included in the present quantitative meta-analysis. The study characteristics are summarized in Table 1 .…”

“…However, the conclusions drawn from previous studies are not consistent. For instance, some studies observed that AF was significantly associated with an increased risk of mortality among COVID-19 patients, [1][2][3] while several other studies reported opposite results that there was no significant relation between AF and unfavorable outcomes of COVID-19 patients. [4][5][6] Several confounding factors such as gender, age and pre-existing medical disorders (diabetes, hypertension, autoimmune diseases, chronic kidney disease, and chronic obstructive pulmonary disease, etc.)…”

The State of Atrial Fibrillation in 2020

“… 2 In a separate publication, Peltzer et al examined the incidence of AF and the correlation with outcomes amongst patients with severe respiratory distress syndrome, also in New York City. 6 In a cohort of 1,053 patients, 18.4% had AF or atrial flutter. Of these, 9.6% of cases involved new-onset disease.…”