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Atrial fibrillation is an independent predictor for in-hospital mortality in patients admitted with SARS-CoV-2 infection

Published:January 22, 2021DOI:https://doi.org/10.1016/j.hrthm.2021.01.018

      Background

      Atrial fibrillation (AF) is the most encountered arrhythmia and has been associated with worse in-hospital outcomes.

      Objective

      This study was to determine the incidence of AF in patients hospitalized with coronavirus disease 2019 (COVID-19) as well as its impact on in-hospital mortality.

      Methods

      Patients hospitalized with a positive COVID-19 polymerase chain reaction test between March 1 and April 27, 2020, were identified from the common medical record system of 13 Northwell Health hospitals. Natural language processing search algorithms were used to identify and classify AF. Patients were classified as having AF or not. AF was further classified as new-onset AF vs history of AF.

      Results

      AF occurred in 1687 of 9564 patients (17.6%). Of those, 1109 patients (65.7%) had new-onset AF. Propensity score matching of 1238 pairs of patients with AF and without AF showed higher in-hospital mortality in the AF group (54.3% vs 37.2%; P < .0001). Within the AF group, propensity score matching of 500 pairs showed higher in-hospital mortality in patients with new-onset AF as compared with those with a history of AF (55.2% vs 46.8%; P = .009). The risk ratio of in-hospital mortality for new-onset AF in patients with sinus rhythm was 1.56 (95% confidence interval 1.42–1.71; P < .0001). The presence of cardiac disease was not associated with a higher risk of in-hospital mortality in patients with AF (P = .1).

      Conclusion

      In patients hospitalized with COVID-19, 17.6% experienced AF. AF, particularly new-onset, was an independent predictor of in-hospital mortality.

      Keywords

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      References

        • Chugh S.S.
        • Havmoeller R.
        • Narayanan K.
        • et al.
        Worldwide epidemiology of atrial fibrillation: a Global Burden of Disease 2010 Study.
        Circulation. 2014; 129: 837-847
        • Colilla S.
        • Crow A.
        • Petkun W.
        • Singer D.E.
        • Simon T.
        • Liu X.
        Estimates of current and future incidence and prevalence of atrial fibrillation in the U.S. adult population.
        Am J Cardiol. 2013; 112: 1142-1147
        • Zoni-Berisso M.
        • Lercari F.
        • Carazza T.
        • Domenicucci S.
        Epidemiology of atrial fibrillation: European perspective.
        Clin Epidemiol. 2014; 6: 213-220
        • McManus D.D.
        • Rienstra M.
        • Benjamin E.J.
        An update on the prognosis of patients with atrial fibrillation.
        Circulation. 2012; 126: e143-e146
        • Chiang C.E.
        • Naditch-Brule L.
        • Murin J.
        • et al.
        Distribution and risk profile of paroxysmal, persistent, and permanent atrial fibrillation in routine clinical practice: insight from the real- life global survey evaluating patients with atrial fibrillation international registry.
        Circ Arrhythm Electrophysiol. 2012; 5: 632-639
        • Clarke D.M.
        • Plumb V.J.
        • Epstein A.E.
        • et al.
        Haemodynamic effects of an irregular sequence of ventricular cycle lengths during atrial fibrillation.
        J Am Coll Cardiol. 1997; 30: 1039-1045
        • Bilaloglu S.
        • Aphinyanaphongs Y.
        • Jones S.
        • Iturrate E.
        • Hochman J.
        • Berger J.S.
        Thrombosis in hospitalized patients with COVID-19 in a New York City health system.
        JAMA. 2020; 324: 799-801
        • Austin P.C.
        Using the standardized difference to compare the prevalence of a binary variable between two groups in observational research.
        Commun Stat Simul Comput. 2009; 38: 1228-1234
        • Austin P.C.
        Comparing paired vs non-paired statistical methods of analyses when making inferences about absolute risk reductions in propensity-score matched samples.
        Stat Med. 2011; 30: 1292-1301
        • Sanyaolu A.
        • Okorie C.
        • Marinkovic A.
        • et al.
        Comorbidity and its impact on patients with COVID-19 [published online ahead of print June 25, 2020]. SN Compr Clin Med.
        • Walkey A.J.
        • Greiner M.A.
        • Heckbert S.R.
        • et al.
        Atrial fibrillation among Medicare beneficiaries hospitalized with sepsis: incidence and risk factors.
        Am Heart J. 2013; 165: 949-955.e3
        • Walkey A.J.
        • Wiener R.S.
        • Ghobrial J.M.
        • Curtis L.H.
        • Benjamin E.J.
        Incident stroke and mortality associated with new-onset atrial fibrillation in patients hospitalized with severe sepsis.
        JAMA. 2011; 306: 2248-2254
        • Bhatla A.
        • Mayer M.M.
        • Adusumalli S.
        • et al.
        COVID-19 and cardiac arrhythmias.
        Heart Rhythm. 2020; 17: 1439-1444
        • Benjamin E.J.
        • Wolf P.A.
        • D’Agostino R.B.
        • Silbershatz H.
        • Kannel W.B.
        • Levy D.
        Impact of atrial fibrillation on the risk of death: the Framingham Heart Study.
        Circulation. 1998; 98: 946-952
        • Stewart S.
        • Hart C.L.
        • Hole D.J.
        • McMurray J.J.
        A population-based study of the long-term risks associated with atrial fibrillation: 20-year follow-up of the Renfrew/Paisley study.
        Am J Med. 2002; 113: 359-364
        • Andersson T.
        • Magnuson A.
        • Bryngelsson I.L.
        • et al.
        All-cause mortality in 272,186 patients hospitalized with incident atrial fibrillation 1995-2008: a Swedish nationwide long-term case- control study.
        Eur Heart J. 2013; 34: 1061-1067
        • Mountantonakis S.E.
        • Grau-Sepulveda M.V.
        • Bhatt D.L.
        • Hernandez A.
        • Peterson E.
        • Fonarow G.
        Presence of atrial fibrillation is independently associated with adverse outcomes in patients hospitalized with heart failure: an analysis of Get With The Guidelines-Heart Failure.
        Circ Heart Fail. 2012; 5: 191-201
        • Gandhi S.
        • Litt D.
        • Narula N.
        New-onset atrial fibrillation in sepsis is associated with increased morbidity and mortality.
        Neth Heart J. 2015; 23: 82-88
        • Kumar G.D.A.
        • Taneja A.
        • Kumar N.
        Atrial fibrillation is more frequent in patients with severe sepsis and septic shock predicts a worse outcome.
        Chest. 2010; 138: 899
        • Wells G.L.
        • Morris P.E.
        Incidence and prognosis of atrial fibrillation in patients with sepsis.
        Cardiol Res. 2011; 2: 293-297
        • Lau D.H.
        • Huynh L.T.
        • Chew D.P.
        • Astley C.M.
        • Soman A.
        • Sanders P.
        Prognostic impact of types of atrial fibrillation in acute coronary syndromes.
        Am J Cardiol. 2009; 104: 1317-1323
        • Sahu B.R.
        • Kampa R.K.
        • Padhi A.
        • Panda A.K.
        C-reactive protein: a promising biomarker for poor prognosis in COVID-19 infection.
        Clin Chim Acta. 2020; 509: 91-94
        • Yamada T.
        • Wakabayashi M.
        • Yamaji T.
        • et al.
        Value of leukocytosis and elevated C-reactive protein in predicting severe coronavirus 2019 (COVID-19): a systematic review and meta-analysis.
        Clin Chim Acta. 2020; 509: 235-243
        • Yao Y.
        • Cao J.
        • Wang Q.
        • et al.
        D-dimer as a biomarker for disease severity and mortality in COVID-19 patients: a case control study.
        J Intensive Care. 2020; 8: 49
        • Sweeney M.
        • Foldes G.
        It takes two: endothelial-perivascular cell cross-talk in vascular development and disease.
        Front Cardiovasc Med. 2018; 5: 154
        • Stark K.
        • Eckart A.
        • Haidari S.
        • et al.
        Capillary and arteriolar pericytes attract innate leukocytes exiting through venules and ‘instruct’ them with pattern-recognition and motility programs.
        Nat Immunol. 2013; 14: 41-51
        • Kennedy-Lydon T.
        Immune functions and properties of resident cells in the heart and cardiovascular system: pericytes.
        Adv Exp Med Biol. 2017; 1003: 93-103
        • Granger D.N.
        • Rodrigues S.F.
        • Yildirim A.
        • Senchenkova E.Y.
        Microvascular responses to cardiovascular risk factors.
        Microcirculation. 2010; 17: 192-205
        • McKinney C.A.
        • Fattah C.
        • Loughrey C.M.
        • Milligan G.
        • Nicklin S.A.
        Angiotensin-(1-7) and angiotensin-(1-9): function in cardiac and vascular remodelling.
        Clin Sci (Lond). 2014; 126: 815-827
        • Jansen H.J.
        • Mackasey M.
        • Moghtadaei M.
        • et al.
        Distinct patterns of atrial electrical and structural remodeling in angiotensin II mediated atrial fibrillation.
        J Mol Cell Cardiol. 2018; 124: 12-25