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Published on: February 26, 2013
AF and in-hospital mortality in COVID-19 patients
Irum D Kotadia1, Maria Dias1, Caroline Roney1
1Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.
Insights
New-onset atrial fibrillation (AF) significantly increases mortality risk in hospitalized COVID-19 patients. Pre-existing AF, however, showed no independent association with poor outcomes, emphasizing the need for monitoring new AF cases.
Area of Science:
- Cardiology
- Infectious Diseases
- Critical Care Medicine
Background:
- Conflicting data exists regarding the association between new-onset atrial fibrillation (AF) and adverse outcomes in COVID-19 patients.
- This study aimed to clarify the independent impact of new-onset AF versus pre-existing AF on clinical outcomes in COVID-19.
- It represents the largest dataset to date, manually curated, comparing outcomes across sinus rhythm, pre-existing AF, and new-onset AF groups.
Purpose of the Study:
- To assess patient outcomes in COVID-19 patients stratified by sinus rhythm, pre-existing AF, and new-onset AF.
- To identify predictors of new-onset AF in individuals with COVID-19 infection.
- To determine if new-onset AF is an independent predictor of mortality in hospitalized COVID-19 patients.
Main Methods:
- A single-center retrospective study included 1241 patients with confirmed COVID-19 admitted between March and September 2020.
- Manual chart review collected demographic, medical history, and clinical outcome data.
- Propensity score matching was employed for adjusted comparisons between AF groups and a no-AF control group.
Main Results:
- Out of 1241 patients, 94 (7.6%) had pre-existing AF and 42 (3.4%) developed new-onset AF.
- New-onset AF was linked to significantly increased in-hospital mortality both before (OR 3.58) and after (OR 2.80) propensity score matching compared to the no-AF group.
- Pre-existing AF did not show an independent association with in-hospital mortality post-matching (OR 1.13).
Conclusions:
- New-onset AF, but not pre-existing AF, is independently associated with elevated mortality in hospitalized COVID-19 patients.
- This finding underscores the importance of vigilant monitoring for new-onset AF in COVID-19 patients.
- Further research is warranted to elucidate the mechanistic links between new-onset AF and adverse clinical outcomes in the context of COVID-19.
Background:
There are conflicting data on whether new-onset atrial fibrillation (AF) is independently associated with poor outcomes in COVID-19 patients. This study represents the largest dataset curated by manual chart review comparing clinical outcomes between patients with sinus rhythm, pre-existing AF, and new-onset AF.
Objective:
The primary aim of this study was to assess patient outcomes in COVID-19 patients with sinus rhythm, pre-existing AF, and new-onset AF. The secondary aim was to evaluate predictors of new-onset AF in patients with COVID-19 infection.
Methods:
This was a single-center retrospective study of patients with a confirmed diagnosis of COVID-19 admitted between March and September 2020. Patient demographic data, medical history, and clinical outcome data were manually collected. Adjusted comparisons were performed following propensity score matching between those with pre-existing or new-onset AF and those without AF.
Results:
The study population comprised of 1241 patients. A total of 94 (7.6%) patients had pre-existing AF and 42 (3.4%) patients developed new-onset AF. New-onset AF was associated with increased in-hospital mortality before (odds ratio [OR] 3.58, 95% confidence interval [CI] 1.78-7.06, P < .005) and after (OR 2.80, 95% CI 1.01-7.77, P < .005) propensity score matching compared with the no-AF group. However, pre-existing AF was not independently associated with in-hospital mortality compared with patients with no AF (postmatching OR: 1.13, 95% CI 0.57-2.21, P = .732).
Conclusion:
New-onset AF, but not pre-existing AF, was independently associated with elevated mortality in patients hospitalised with COVID-19. This observation highlights the need for careful monitoring of COVID-19 patients with new-onset AF. Further research is needed to explain the mechanistic relationship between new-onset AF and clinical outcomes in COVID-19 patients.
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