Outcomes and mortality associated with atrial arrhythmias among patients hospitalized with COVID-19

J Cardiovasc Electrophysiol. 2020 Dec;31(12):3077-3085. doi: 10.1111/jce.14770. Epub 2020 Oct 14.

Abstract

Introduction: The impact of atrial arrhythmias on coronavirus disease 2019 (COVID-19)-associated outcomes are unclear. We sought to identify prevalence, risk factors and outcomes associated with atrial arrhythmias among patients hospitalized with COVID-19.

Methods: An observational cohort study of 1053 patients with severe acute respiratory syndrome coronavirus 2 infection admitted to a quaternary care hospital and a community hospital was conducted. Data from electrocardiographic and telemetry were collected to identify atrial fibrillation (AF) or atrial flutter/tachycardia (AFL). The association between atrial arrhythmias and 30-day mortality was assessed with multivariable analysis.

Results: Mean age of patients was 62 ± 17 years and 62% were men. Atrial arrhythmias were identified in 166 (15.8%) patients, with AF in 154 (14.6%) patients and AFL in 40 (3.8%) patients. Newly detected atrial arrhythmias occurred in 101 (9.6%) patients. Age, male sex, prior AF, renal disease, and hypoxia on presentation were independently associated with AF/AFL occurrence. Compared with patients without AF/AFL, patients with AF/AFL had significantly higher levels of troponin, B-type natriuretic peptide, C-reactive protein, ferritin and d-dimer. Mortality was significantly higher among patients with AF/AFL (39.2%) compared to patients without (13.4%; p < .001). After adjustment for age and co-morbidities, AF/AFL (adjusted odds ratio [OR]: 1.93; p = .007) and newly detected AF/AFL (adjusted OR: 2.87; p < .001) were independently associated with 30-day mortality.

Conclusion: Atrial arrhythmias are common among patients hospitalized with COVID-19. The presence of AF/AFL tracked with markers of inflammation and cardiac injury. Atrial arrhythmias were independently associated with increased mortality.

Keywords: COVID-19; atrial fibrillation; atrial flutter; mortality; outcomes.

Publication types

  • Multicenter Study
  • Observational Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Atrial Fibrillation / diagnosis
  • Atrial Fibrillation / mortality*
  • Atrial Fibrillation / therapy
  • Atrial Flutter / diagnosis
  • Atrial Flutter / mortality*
  • Atrial Flutter / therapy
  • COVID-19 / diagnosis
  • COVID-19 / mortality*
  • COVID-19 / therapy
  • Female
  • Hospital Mortality*
  • Hospitalization*
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • New York City / epidemiology
  • Prevalence
  • Prognosis
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Time Factors