In-hospital AF, atrial flutter confer worse outcomes in patients with COVID-19
Among patients hospitalized with COVID-19, atrial fibrillation and atrial flutter are common and are associated with worse outcomes, according to findings presented at the virtual American Heart Association Scientific Sessions.
Zaniar Ghazizadeh, MD, internal medicine resident at Yale New Haven Hospital and Yale School of Medicine, and colleagues conducted a retrospective medical review on 435 hospitalized patients (mean age, 68 years; 52% men; 56% white) with COVID-19 from the Yale Cardiovascular COVID Registry from March to June. Researchers calculated rates of prior and in-hospital AF and atrial flutter and evaluated rates of in-hospital adverse events.
In total, 15.7% of patients had prior AF and atrial flutter. In-hospital AF and atrial flutter occurred in 19.9% of patients and, of these, 7.83% did not have prior AF or atrial flutter. Those with in-hospital AF and atrial flutter had significantly more CV complications, including cardiac injury (78.5% vs. 42.7%), type 2 MI (53.3% vs. 30.3%) and HF (32.9% vs. 9.2%) compared with those without.
Compared with patients without it, patients with in-hospital AF or atrial flutter had worse COVID-19-related outcomes, including ICU survival (OR = 0.22; 95% CI, 0.08-0.59; P = .002), HF (OR = 5.19; 95% CI, 2.56-10.5; P = .000), myocardial injury (OR = 2.87; 95% CI, 1.49-5.49; P = .001), acute kidney injury (OR = 2.02; 95% CI, 1.09-3.74; P = .027), dialysis (OR = 4.07; 95% CI, 1.38-12.03; P = .011) and hospice or death (OR = 2.47; 95% CI, 1.35-4.53; P = .004).
More investigation to understand the mechanisms of heart injury from COVID-19 and methods to prevent further complications is necessary, according to the researchers.
“Our study suggests that the combination of COVID-19 and atrial arrhythmias may create a pathologic synergy that markedly increases the risk for major adverse cardiac events and death,” Ghazizadeh said in a press release. “COVID-19 places patients at a high risk for abnormal heart rhythms that are, in turn, associated with markedly worse outcomes, including death and multi-organ failure. Patients and physicians need to monitor for these arrhythmias closely and treatments need to be timely.”
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Ghazizadeh Z, et al. Abstract P2355. Presented at: American Heart Association Scientific Sessions; Nov. 13-17, 2020 (virtual meeting).