Key result
New-onset AF in COVID-19 hospitalizations is linked to ~71% higher odds of mortality.
Why the study?
The study aimed to determine the association between atrial fibrillation and mortality, ICU admission, complications, and discharge destination in hospitalised COVID-19 patients.
Does new-onset atrial fibrillation increase the risk of mortality and complications in hospitalized COVID-19 patients?
Cohort (n=3,064)
Yes
Does new-onset atrial fibrillation increase the risk of mortality and complications in hospitalized COVID-19 patients?
New-onset atrial fibrillation in hospitalized COVID-19 patients acts as a significant marker of disease severity and is strongly associated with increased mortality and ICU admission.
May flag higher-risk COVID-19 inpatients for monitoring; leaves open causality and need for prospective trials.
OBJECTIVES: The aim of this multicentre COVID-PREDICT study (a nationwide observational cohort study that aims to better understand clinical course of COVID-19 and to predict which COVID-19 patients should receive which treatment and which type of care) was to determine the association between atrial fibrillation (AF) and mortality, intensive care unit (ICU) admission, complications and discharge destination in hospitalised COVID-19 patients. SETTING: Data from a historical cohort study in eight hospitals (both academic and non-academic) in the Netherlands between January 2020 and July 2021 were used in this study. PARTICIPANTS: 3064 hospitalised COVID-19 patients >18 years old. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was the incidence of new-onset AF during hospitalisation. Secondary outcomes were the association between new-onset AF (vs prevalent or non-AF) and mortality, ICU admissions, complications and discharge destination, performed by univariable and multivariable logistic regression analyses. RESULTS: Of the 3064 included patients (60.6% men, median age: 65 years, IQR 55-75 years), 72 (2.3%) patients had prevalent AF and 164 (5.4%) patients developed new-onset AF during hospitalisation. Compared with patients without AF, patients with new-onset AF had a higher incidence of death (adjusted OR (aOR) 1.71, 95% CI 1.17 to 2.59) an ICU admission (aOR 5.45, 95% CI 3.90 to 7.61). Mortality was non-significantly different between patients with prevalent AF and those with new-onset AF (aOR 0.97, 95% CI 0.53 to 1.76). However, new-onset AF was associated with a higher incidence of ICU admission and complications compared with prevalent AF (OR 6.34, 95% CI 2.95 to 13.63, OR 3.04, 95% CI 1.67 to 5.55, respectively). CONCLUSION: New-onset AF was associated with an increased incidence of death, ICU admission, complications and a lower chance to be discharged home. These effects were far less pronounced in patients with prevalent AF. Therefore, new-onset AF seems to represent a marker of disease severity, rather than a cause of adverse outcomes.
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Spruit et al. (2023) conducted a cohort in Hospitalized COVID-19 (n=3,064). New-onset atrial fibrillation vs. No atrial fibrillation was evaluated on All-cause mortality (aOR 1.71, 95% CI 1.17-2.59). New-onset atrial fibrillation during hospitalization for COVID-19 was associated with an increased risk of mortality (aOR 1.71) and ICU admission compared to patients without atrial fibrillation.
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