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Prognostic value of initial electrocardiography in predicting long-term all-cause mortality in COVID-19
Nicholas Kassis1, Ashish Kumar2, Shravani Gangidi1
1Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA.
Insights
Initial electrocardiography (ECG) findings of sinus tachycardia and atrial fibrillation (AF) strongly predict long-term mortality in COVID-19 patients. ECG is a valuable tool for assessing long-term prognosis in coronavirus disease 2019.
Area of Science:
- Cardiology
- Infectious Diseases
- Public Health
Background:
- Electrocardiography (ECG) has established short-term prognostic value in coronavirus disease 2019 (COVID-19).
- The predictive capacity of initial ECG for long-term mortality in COVID-19 patients remains largely unknown.
- This study investigates the role of baseline ECG in predicting long-term all-cause mortality in COVID-19 survivors.
Purpose of the Study:
- To determine if initial electrocardiography (ECG) characteristics can predict long-term all-cause mortality in patients diagnosed with COVID-19.
- To assess the association between specific ECG findings and long-term mortality outcomes.
- To evaluate the utility of ECG as a prognostic tool for COVID-19 patients.
Main Methods:
- Prospective cohort study of adults with COVID-19 who underwent ECG within a 17-hospital system.
- Expert ECG reader analyzed all studies blinded to patient outcomes.
- Cox proportional hazards regression and multivariable logistic regression models were used to assess associations with mortality and ICU admission.
Main Results:
- Of 837 patients, 206 (24.6%) died at final follow-up (median 21 days post-ECG).
- Sinus tachycardia and atrial fibrillation (AF) independently predicted all-cause mortality after multivariable adjustment.
- Patients with AF had a 64.5% probability of death versus 20.5% for normal sinus rhythm (P<.0001).
Conclusions:
- Initial ECG findings of sinus tachycardia and AF are strong predictors of long-term all-cause mortality in COVID-19.
- Electrocardiography can serve as a powerful prognostic tool for assessing long-term outcomes in COVID-19 patients.
- These findings highlight the importance of ECG in risk stratification for COVID-19 survivors.
Background:
The electrocardiography (ECG) has short-term prognostic value in coronavirus disease 2019 (COVID-19), yet its ability to predict long-term mortality is unknown. This study aimed to elucidate the predictive role of initial ECG on long-term all-cause mortality in patients diagnosed with COVID-19.
Methods:
In this prospective cohort study, adults with COVID-19 who underwent ECG testing within a 17-hospital health system in Northeast Ohio and Florida between 03/2020-06/2020 were identified. An expert ECG reader analyzed all studies blinded to patient status. The associations of ECG characteristics with long-term all-cause mortality and intensive care unit (ICU) admission were assessed using Cox proportional hazards regression model and multivariable logistic regression models, respectively. Status of long-term mortality was adjudicated on 01/07/2022.
Results:
Of 837 patients (median age 65 years, 51% female, 44% Black), 683 (81.6%) were hospitalized, 281 (33.6%) required ICU admission, 67 (8.0%) died in-hospital, and 206 (24.6%) died at final follow-up after a median (IQR) of 21 (9-103) days after ECG. Overall, 179 (20.7%) patients presented with sinus tachycardia, 12 (1.4%) with atrial flutter, and 45 (5.4%) with atrial fibrillation (AF). After multivariable adjustment, sinus tachycardia (E-value for HR=3.09, lower CI=2.2) and AF (E-value for HR=3.13, lower CI=2.03) each independently predicted all-cause mortality. At final follow-up, patients with AF had 64.5% probability of death compared with 20.5% for those with normal sinus rhythm (P<.0001).
Conclusions:
Sinus tachycardia and AF on initial ECG strongly predict long-term all-cause mortality in COVID-19. The ECG can serve as a powerful long-term prognostic tool in COVID-19.
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