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Published on: February 26, 2013
Incident Atrial Fibrillation and In-Hospital Mortality in SARS-CoV-2 Patients
Alessandro Maloberti1,2, Cristina Giannattasio1,2, Paola Rebora3
1Cardiology 4, "A. De Gasperis" Cardio Center, ASST GOM Niguarda Ca' Granda, 20162 Milan, Italy.
Insights
New-onset atrial fibrillation (AF) is a frequent complication in hospitalized COVID-19 patients. This condition significantly predicts in-hospital mortality, highlighting the importance of monitoring for arrhythmia in these patients.
Area of Science:
- Cardiology
- Infectious Diseases
- Critical Care Medicine
Background:
- Cardiovascular complications of COVID-19 are increasingly recognized, with arrhythmia and atrial fibrillation (AF) gaining attention.
- Understanding the incidence and prognostic implications of AF in COVID-19 patients is crucial for clinical management.
Purpose of the Study:
- To determine the incidence of new-onset atrial fibrillation (AF) in patients hospitalized with COVID-19.
- To assess the predictive value of incident AF for in-hospital all-cause mortality among COVID-19 patients.
Main Methods:
- A cohort of 3435 patients with SARS-CoV-2 infection admitted to Northern Italian hospitals between February 2020 and May 2021 was analyzed.
- Data collected included clinical history, laboratory tests, treatments, and intensive care unit (ICU) admission.
- Incident AF and in-hospital mortality were the primary outcomes assessed using Cox regression models.
Main Results:
- 145 patients (4.2%) developed new-onset AF during hospitalization, with a median onset of 3 days post-admission.
- Patients with incident AF had higher rates of ICU admission (39.3% vs. 12.4%) and in-hospital mortality (37.2% vs. 16.9%).
- Significant predictors of incident AF included age, prior AF history, low lymphocyte count, reduced eGFR, and ICU admission. Incident AF, along with age, male gender, dementia, low platelet and lymphocyte counts, elevated CRP, reduced eGFR, and ICU admission, predicted mortality.
Conclusions:
- New-onset atrial fibrillation is a common complication in hospitalized COVID-19 patients.
- The occurrence of incident AF is a strong independent predictor of in-hospital mortality in this patient population.
Abstract:
(1) Background: Among the different cardiovascular (CV) manifestations of the coronavirus disease 2019 (COVID-19), arrhythmia and atrial fibrillation (AF) in particular have recently received special attention. The aims of our study were to estimate the incidence of AF in patients hospitalized for COVID-19, and to evaluate its role as a possible predictor of in-hospital all-cause mortality. (2) Methods: We enrolled 3435 people with SARS-CoV2 infection admitted to three hospitals in Northern Italy from February 2020 to May 2021. We collected data on their clinical history, laboratory tests, pharmacological treatment and intensive care unit (ICU) admission. Incident AF and all-cause in-hospital mortality were considered as outcomes. (3) Results: 145 (4.2%) patients developed AF during hospitalization, with a median time since admission of 3 days (I-III quartile: 0, 12). Patients with incident AF were admitted more frequently to the ICU (39.3 vs. 12.4%, p < 0.001), and more frequently died (37.2 vs. 16.9%, p < 0.001). In the Cox regression model, the significant determinants of incident AF were age (HR: 1.041; 95% CI: 1.022, 1.060 per year), a history of AF (HR: 2.720; 95% CI: 1.508, 4.907), lymphocyte count (HR: 0.584; 95% CI: 0.384, 0.888 per 103/µL), estimated glomerular filtration rate (eGFR, HR: 0.988; 95% CI: 0.980, 0.996 per mL/min) and ICU admission (HR: 5.311; 95% CI: 3.397, 8.302). Incident AF was a predictor of all-cause mortality (HR: 1.405; 95% CI: 1.027, 1.992) along with age (HR: 1.057; 95% CI: 1.047, 1.067), male gender (HR: 1.315; 95% CI: 1.064; 1.626), dementia (HR: 1.373; 95% CI: 1.045, 1.803), lower platelet (HR: 0.997; 95% CI: 0.996, 0.998 per 103/µL) and lymphocyte counts (HR: 0.843; 95% CI: 0.725, 0.982 per 103/µL), C-Reactive protein values (HR: 1.004; 95% CI: 1.003, 1.005 per mg/L), eGFR (HR: 0.990; 95% CI: 0.986, 0.994 per mL/min), and ICU admission (HR: 1.759; 95% CI: 1.292, 2.395). (4) Conclusions: Incident AF is a common complication in COVID-19 patients during hospitalization, and its occurrence strongly predicts in-hospital mortality.
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