Prognostic value of ECG monitor findings in COVID-19
Hidenobu Hashimoto1,2, Yasunaga Hiyoshi3, Takayuki Kabuki3,2
1Department of Cardiovascular Medicine, Tokyo Metropolitan Ebara Hospital, Tokyo, Japan hidenobu.hashimoto@med.toho-u.ac.jp.
Insights
Continuous electrocardiographic monitoring in COVID-19 patients identified atrial fibrillation and lung disease complications as significant predictors of mortality. This simple method offers prognostic value for hospitalized COVID-19 patients.
Area of Science:
- Cardiology
- Infectious Diseases
- Critical Care Medicine
Background:
- COVID-19 can lead to severe illness and multiorgan dysfunction, including acute myocardial damage.
- Electrocardiographic (ECG) findings may indicate COVID-19 severity, but standard ECGs pose exposure risks to healthcare workers.
- Continuous electrocardiographic monitoring offers a safer alternative for assessing COVID-19 patient prognosis.
Purpose of the Study:
- To evaluate the prognostic value of continuous electrocardiographic monitor findings in hospitalized COVID-19 patients.
- To identify specific ECG patterns associated with in-hospital mortality in COVID-19.
- To assess the utility of continuous ECG monitoring as a risk stratification tool.
Main Methods:
- Retrospective analysis of 96 COVID-19 patients (76±4 years) who underwent continuous electrocardiographic monitoring.
- Independent cardiologists blinded to clinical data analyzed ECG monitor data.
- Multivariate Cox regression models assessed the association between ECG findings, clinical data, and all-cause mortality.
Main Results:
- In-hospital mortality occurred in 18% of patients during a mean hospitalization of 22.8±3.2 days.
- Atrial fibrillation (HR: 3.95) and lung disease complications (HR: 2.91) were significant independent predictors of mortality.
- The combination of atrial fibrillation and lung disease complications significantly increased mortality risk (HR: 8.37, p=0.009).
Conclusions:
- Continuous electrocardiographic monitoring can effectively detect atrial fibrillation in COVID-19 patients.
- Atrial fibrillation, particularly when complicated by lung disease, is a valuable prognostic indicator for COVID-19 patients.
- This monitoring method provides crucial prognostic information, aiding in risk stratification and patient management.
Aims:
COVID-19 can cause severe illness and multiorgan dysfunction. Acute myocardial damage has been detected in a significant portion of patients with COVID-19; therefore, several studies have reported that electrocardiographic findings could be used to evaluate the severalty of COVID-19. However, performing standard ECG for each patient hospitalised with COVID-19 can increase the level of exposure to COVID-19 among medical staff. Therefore, this study aimed to investigate the prognostic value of continuous electrocardiographic monitor findings in patients with COVID-19.
Methods:
Among 1612 consecutive patients with COVID-19 who were admitted to our hospital between August 2021 and May 2022, we identified 96 (76±4 years) patients who underwent electrocardiographic monitor during hospitalisation. All electrocardiographic monitors were analysed by two independent cardiologists blinded to the clinical data of the patients. The endpoint was defined as the occurrence of all-cause mortality related to COVID-19. The event data were retrospectively gathered from the patients' medical records. A multivariate Cox model was used to assess whether these electrocardiographic monitor findings and clinical data were associated with in-hospital mortality.
Results:
During a mean hospitalisation period of 22.8±3.2 days, in-hospital mortality occurred in 17 (18%) patients. Atrial fibrillation (HR: 3.95, 95% CI: 1.39 to 11.21) and lung disease complications (HR: 2.91, 95% CI: 1.06 to 7.98) were significant prognostic factors for death in multivariate analysis. Compared with the non-complicated lung disease and non-atrial fibrillation group, the risk of mortality was significantly higher in the lung disease complication and atrial fibrillation group in the multivariate Cox proportional model (HR: 8.37, 95% CI: 1.69 to 41.30, p=0.009).
Conclusions:
The simple method of ECG monitor could adequately detect atrial fibrillation. This study demonstrated that atrial fibrillation complicated with lung disease, could have potential prognostic value among patients with COVID-19.
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