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Implications of atrial fibrillation on the clinical course and outcomes of hospitalized COVID-19 patients: results of the Cardio-COVID-Italy multicentre study

2021; Oxford University Press; Volume: 23; Issue: 10 Linguagem: Inglês

10.1093/europace/euab146

1532-2092

Sara París, Riccardo M. Inciardi, Carlo Lombardi, Daniela Tomasoni, Pietro Ameri, Valentina Carubelli, Piergiuseppe Agostoni, Claudia Canale, Stefano Carugo, Gian Battista Danzi, Mattia Di Pasquale, Filippo M. Sarullo, Maria Teresa La Rovere, Andrea Mortara, Massimo Piepoli, Italo Porto, Gianfranco Sinagra, Maurizio Volterrani, Massimiliano Gnecchi, Sergio Leonardi, Marco Merlo, Alfonso Iorio, Stefano Giovinazzo, Antonio Bellasi, G Zaccone, Rita Camporotondo, Francesco Catagnano, Laura Adelaide Dalla Vecchia, Gloria Maccagni, Massimo Mapelli, Davide Margonato, Luca Monzo, Vincenzo Nuzzi, Andrea Pozzi, Giovanni Provenzale, Claudia Specchia, Chiara Tedino, Marco Guazzi, Michele Senni, Marco Metra,

Atrial Fibrillation Management and Outcomes

Abstract Aims To assess the clinical relevance of a history of atrial fibrillation (AF) in hospitalized patients with coronavirus disease 2019 (COVID-19). Methods and results We enrolled 696 consecutive patients (mean age 67.4 ± 13.2 years, 69.7% males) admitted for COVID-19 in 13 Italian cardiology centres between 1 March and 9 April 2020. One hundred and six patients (15%) had a history of AF and the median hospitalization length was 14 days (interquartile range 9–24). Patients with a history of AF were older and with a higher burden of cardiovascular risk factors. Compared to patients without AF, they showed a higher rate of in-hospital death (38.7% vs. 20.8%; P < 0.001). History of AF was associated with an increased risk of death after adjustment for clinical confounders related to COVID-19 severity and cardiovascular comorbidities, including history of heart failure (HF) and increased plasma troponin [adjusted hazard ratio (HR): 1.73; 95% confidence interval (CI) 1.06–2.84; P = 0.029]. Patients with a history of AF also had more in-hospital clinical events including new-onset AF (36.8% vs. 7.9%; P < 0.001), acute HF (25.3% vs. 6.3%; P < 0.001), and multiorgan failure (13.9% vs. 5.8%; P = 0.010). The association between AF and worse outcome was not modified by previous or concomitant use of anticoagulants or steroid therapy (P for interaction >0.05 for both) and was not related to stroke or bleeding events. Conclusion Among hospitalized patients with COVID-19, a history of AF contributes to worse clinical course with a higher mortality and in-hospital events including new-onset AF, acute HF, and multiorgan failure. The mortality risk remains significant after adjustment for variables associated with COVID-19 severity and comorbidities.