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COVID-19 and comedications in atrial fibrillation-a case-control study in Stockholm

Max Bell1,2, Anders Ekbom3, Marie Linder4

  • 1Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, 171 76, Stockholm, Sweden.

European Journal of Epidemiology
|January 27, 2023
PubMed

Insights

Anticoagulation use in atrial fibrillation (AF) patients with COVID-19 significantly lowered hospitalization and death risks. This highlights the importance of anticoagulant therapy for vulnerable populations during viral infections.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Public Health

Background:

  • COVID-19 poses significant risks, including hospitalization, ICU admission, and death, particularly for individuals with underlying health conditions.
  • Atrial fibrillation (AF) is a common arrhythmia associated with an increased risk of thromboembolic events, necessitating anticoagulation therapy.
  • The prothrombotic nature of COVID-19 raises questions about the role of anticoagulation in managing infected patients with AF.

Purpose of the Study:

  • To investigate the hypothesis that anticoagulation therapy reduces the risk of hospitalization, ICU admission, and death in patients with atrial fibrillation (AF) diagnosed with COVID-19.
  • To assess the association between antithrombotic use and COVID-19 related outcomes in a large cohort of AF patients.

Main Methods:

  • A nested case-control study was conducted using data from Swedish national and regional registers (1997-2020).
  • COVID-19 cases (hospitalization, ICU admission, or death) among individuals with AF in Stockholm were identified and matched to disease-free controls.
  • Data linkage via personal identity numbers allowed comprehensive tracking of healthcare encounters, including primary care, outpatient clinics, and hospitalizations.

Main Results:

  • The study included 7548 COVID-19 cases and 37,145 controls from a source population of 179,381 individuals with AF.
  • Antithrombotic use was associated with a reduced odds ratio (OR) for COVID-19 related outcomes: 0.79 (95% CI, 0.66-0.95) during the first wave and 0.80 (95% CI, 0.64-1.01) during the second wave.
  • Specifically, anticoagulation was linked to a lower risk of hospitalization and death among AF patients infected with COVID-19.

Conclusions:

  • Anticoagulation therapy in patients with atrial fibrillation (AF) and COVID-19 infection is associated with a significantly lower risk of hospitalization and mortality.
  • These findings underscore the importance of ensuring adherence to anticoagulation regimens for vulnerable AF patients during COVID-19 and potentially other infections with prothrombotic properties.
  • The study emphasizes the need for continued vigilance and management of anticoagulation in high-risk patient populations facing infectious threats.

Keywords:
AnticoagulantsCOVID-19Communicable diseasesEpidemiology

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