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New-Onset Atrial Fibrillation in Patients Hospitalized With COVID-19: Results From the American Heart Association
Anna G Rosenblatt1, Colby R Ayers1, Anjali Rao1
1Division of Cardiology, Department of Medicine, University of Texas Southwestern, Dallas, TX (A.G.R., C.R.A., A.R., N.S.H., J.D.D., M.S.L., J.A.d.L., S.R.D.).
Insights
New-onset atrial fibrillation (AF) occurred in 5.4% of COVID-19 hospitalizations. While initially linked to higher mortality, AF was not an independent predictor after adjusting for other health factors.
Area of Science:
- Cardiology
- Infectious Diseases
- Epidemiology
Background:
- New-onset atrial fibrillation (AF) is a recognized complication in patients hospitalized with COVID-19.
- This complication has been associated with adverse clinical outcomes, necessitating further investigation.
Purpose of the Study:
- To determine the incidence of new-onset AF in a diverse US cohort of COVID-19 patients.
- To evaluate the clinical outcomes, including mortality and major adverse cardiovascular events (MACE), associated with new-onset AF.
Main Methods:
- Utilized data from the American Heart Association COVID-19 Cardiovascular Disease Registry.
- Stratified patients based on the presence or absence of new-onset AF.
- Employed Cox proportional-hazards models to assess the association between new-onset AF and in-hospital mortality and MACE.
Main Results:
- 5.4% of 27,851 COVID-19 patients without prior AF history developed new-onset AF during hospitalization.
- New-onset AF was associated with significantly higher unadjusted rates of death (45.2% vs. 11.9%) and MACE (23.8% vs. 6.5%).
- After multivariable adjustment, the association of new-onset AF with death attenuated, while its association with MACE was partially attenuated.
Conclusions:
- New-onset AF is a common finding in hospitalized COVID-19 patients.
- While associated with poor outcomes, new-onset AF may serve as a marker for other adverse clinical factors rather than an independent driver of mortality.
- Further research is needed to establish causality between new-onset AF and MACE in this population.
Background:
New-onset atrial fibrillation (AF) in patients hospitalized with COVID-19 has been reported and associated with poor clinical outcomes. We aimed to understand the incidence of and outcomes associated with new-onset AF in a diverse and representative US cohort of patients hospitalized with COVID-19.
Methods:
We used data from the American Heart Association COVID-19 Cardiovascular Disease Registry. Patients were stratified by the presence versus absence of new-onset AF. The primary and secondary outcomes were in-hospital mortality and major adverse cardiovascular events (MACE; cardiovascular death, myocardial infarction, stroke, cardiogenic shock, and heart failure). The association of new-onset AF and the primary and secondary outcomes was evaluated using Cox proportional-hazards models for the primary time to event analyses.
Results:
Of the first 30 999 patients from 120 institutions across the United States hospitalized with COVID-19, 27 851 had no history of AF. One thousand five hundred seventeen (5.4%) developed new-onset AF during their index hospitalization. New-onset AF was associated with higher rates of death (45.2% versus 11.9%) and MACE (23.8% versus 6.5%). The unadjusted hazard ratio for mortality was 1.99 (95% CI, 1.81-2.18) and for MACE was 2.23 (95% CI, 1.98-2.53) for patients with versus without new-onset AF. After adjusting for demographics, clinical comorbidities, and severity of disease, the associations with death (hazard ratio, 1.10 [95% CI, 0.99-1.23]) fully attenuated and MACE (hazard ratio, 1.31 [95% CI, 1.14-1.50]) partially attenuated.
Conclusions:
New-onset AF was common (5.4%) among patients hospitalized with COVID-19. Almost half of patients with new-onset AF died during their index hospitalization. After multivariable adjustment for comorbidities and disease severity, new-onset AF was not statistically significantly associated with death, suggesting that new-onset AF in these patients may primarily be a marker of other adverse clinical factors rather than an independent driver of mortality. Causality between the MACE composites and AF needs to be further evaluated.
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