Predictors and Prognostic Implications of Cardiac Arrhythmias in Patients Hospitalized for COVID-19

Abstract

Background: Cardiac manifestation of COVID-19 has been reported during the COVID pandemic. The role of cardiac arrhythmias in COVID-19 is insufficiently understood. This study assesses the incidence of cardiac arrhythmias and their prognostic implications in hospitalized COVID-19-patients. Methods: A total of 166 patients from eight centers who were hospitalized for COVID-19 from 03/2020–06/2020 were included. Medical records were systematically analyzed for baseline characteristics, biomarkers, cardiac arrhythmias and clinical outcome parameters related to the index hospitalization. Predisposing risk factors for arrhythmias were identified. Furthermore, the influence of arrhythmia on the course of disease and related outcomes was assessed using univariate and multiple regression analyses. Results: Arrhythmias were detected in 20.5% of patients. Atrial fibrillation was the most common arrhythmia. Age and cardiovascular disease were predictors for new-onset arrhythmia. Arrhythmia was associated with a pronounced increase in cardiac biomarkers, prolonged hospitalization, and admission to intensive- or intermediate-care-units, mechanical ventilation and in-hospital mortality. In multiple regression analyses, incident arrhythmia was strongly associated with duration of hospitalization and mechanical ventilation. Cardiovascular disease was associated with increased mortality. Conclusions: Arrhythmia was the most common cardiac event in association with hospitalization for COVID-19. Older age and cardiovascular disease predisposed for arrhythmia during hospitalization. Whereas in-hospital mortality is affected by underlying cardiovascular conditions, arrhythmia during hospitalization for COVID-19 is independently associated with prolonged hospitalization and mechanical ventilation. Thus, incident arrhythmia may indicate a patient subgroup at risk for a severe course of disease.

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

“…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 .…”

“…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 , …”

“…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.…”

“…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.…”

“…The evaluation of bias for the two outcomes investigated is reported in Supplementary Materials (Tables S2 and S3, respectively) . Among studies reporting the prevalence of AF, 13 studies were categorized as being at high risk of bias [ 11 , 32 , 33 , 34 , 36 , 37 , 39 , 42 , 44 , 46 , 47 , 48 , 51 ]; incomplete reporting of baseline characteristics was the most common concern. Among the studies reporting all-cause mortality according to AF, two studies were at high risk of bias [ 42 , 50 ].…”