Key result
New-onset atrial fibrillation or atrial flutter during COVID-19 hospitalization was associated with a two- to three-fold increased risk of in-hospital mortality specifically in males aged 60 to 72 years.
Why the study?
New-onset AF and AFL during COVID-19 hospitalisation are associated with increased mortality, but how this risk is impacted by age and sex is poorly understood.
Does new-onset atrial fibrillation or atrial flutter increase in-hospital mortality in hospitalized COVID-19 patients?
Cohort (n=5,782)
Yes
Does new-onset atrial fibrillation or atrial flutter increase in-hospital mortality in hospitalized COVID-19 patients?
May flag higher-risk COVID-19 males aged 60-72 for closer monitoring; leaves open causal role and intervention targets.
BACKGROUND: Coronavirus disease 2019 (COVID-19) is a systemic disease with cardiovascular involvement, including cardiac arrhythmias. Notably, new-onset atrial fibrillation (AF) and atrial flutter (AFL) during hospitalisation in COVID-19 patients has been associated with increased mortality. However, how this risk is impacted by age and sex is still poorly understood. METHODS: For this multicentre cohort study, we extracted demographics, medical history, occurrence of electrical disorders and in-hospital mortality from the large international patient registry CAPACITY-COVID. For each electrical disorder, prevalence during hospitalisation was calculated. Subsequently, we analysed the incremental prognostic effect of developing AF/AFL on in-hospital mortality, using multivariable logistic regression analyses, stratified for sex and age. RESULTS: In total, 5782 patients (64% male; median age 67) were included. Of all patients 11.0% (95% CI 10.2-11.8) experienced AF and 1.6% (95% CI 1.3-1.9) experienced AFL during hospitalisation. Ventricular arrhythmias were rare (<0.8% (95% CI 0.6-1.0)) and a conduction disorder was observed in 6.3% (95% CI 5.7-7.0). An event of AF/AFL appeared to occur more often in patients with pre-existing heart failure. After multivariable adjustment for age and sex, new-onset AF/AFL was significantly associated with a poorer prognosis, exemplified by a two- to three-fold increased risk of in-hospital mortality in males aged 60-72 years, whereas this effect was largely attenuated in older male patients and not observed in female patients. CONCLUSION: In this large COVID-19 cohort, new-onset AF/AFL was associated with increased in-hospital mortality, yet this increased risk was restricted to males aged 60-72 years.
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Offerhaus et al. (2022) conducted a cohort in COVID-19 (n=5,782). New-onset atrial fibrillation and/or atrial flutter vs. No new-onset atrial fibrillation or atrial flutter was evaluated on In-hospital mortality (OR 1.90, 95% CI 1.52-2.36). New-onset atrial fibrillation or atrial flutter during COVID-19 hospitalization was associated with a two- to three-fold increased risk of in-hospital mortality specifically in males aged 60 to 72 years.
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