New-Onset Atrial Fibrillation in Patients With Coronavirus Disease 2019 (COVID-19) and Cardiovascular Disease ― Insights From the CLAVIS-COVID Registry ―

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: COVID-19 with cardiovascular diseases and risk factors (n=673). Intervention: New-onset atrial fibrillation (NOAF) vs. Pre-existing atrial fibrillation and sinus rhythm. Primary outcome: In-hospital mortality (OR 4.71, 95% CI 1.63-13.6, p=<0.001).

doi:10.1253/circj.cj-21-0911

January 25, 2022Circulation JournalOpen Access

New-Onset Atrial Fibrillation in Patients With Coronavirus Disease 2019 (COVID-19) and Cardiovascular Disease ― Insights From the CLAVIS-COVID Registry ―

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Key result

New-onset atrial fibrillation was independently associated with a significantly higher risk of in-hospital mortality (OR 4.71) compared to pre-existing atrial fibrillation and sinus rhythm.

Why the study?

Pre-existing and new-onset AF are observed in COVID-19 patients, but the effect of AF on clinical outcomes remains unclear.

Does new-onset atrial fibrillation increase in-hospital mortality in hospitalized patients with COVID-19 and cardiovascular disease?

Key Points

To determine the impact of pre-existing and new-onset atrial fibrillation on in-hospital clinical outcomes among hospitalized COVID-19 patients with cardiovascular disease and risk factors.
Analyzed 673 hospitalized COVID-19 patients with cardiovascular disease and risk factors enrolled in the CLAVIS-COVID registry.
Categorized patients into three clinical groups: pre-existing atrial fibrillation (n=55), new-onset atrial fibrillation (n=28), and sinus rhythm (n=590).
In-hospital mortality was significantly higher in patients with new-onset atrial fibrillation (42.9%) compared to pre-existing atrial fibrillation (30.9%) and sinus rhythm (11.2%) (P<0.001).
New-onset atrial fibrillation was independently associated with in-hospital mortality after adjusting for pre-existing atrial fibrillation and the 4C mortality score (OR: 4.71, 95% CI: 1.63–13.6, P<0.001).
Patients with new-onset atrial fibrillation had an increased incidence of acute respiratory syndrome, multiple organ disease, hemorrhage, and stroke compared to the other groups.

Study Design

Type

Cohort (n=673)

Multicenter

Yes

Structured PICO

Does new-onset atrial fibrillation increase in-hospital mortality in hospitalized patients with COVID-19 and cardiovascular disease?

P

Population

673 hospitalized adults aged 20 and older with COVID-19 and underlying cardiovascular diseases or risk factors, evaluated for in-hospital outcomes.

E

Exposure

New-onset atrial fibrillation (NOAF) after admission, sustained for >24 h (n=28)

C

Comparator

Pre-existing atrial fibrillation (n=55) and sinus rhythm (n=590)

O

Outcome

In-hospital mortalityhard clinical

Main Result

Odds Ratio: 4.71 (95% CI 1.63–13.6)

Absolute Event Rate: 42.9% vs 11.2%

p-value: p=<0.001

New-onset atrial fibrillation is a strong, independent predictor of in-hospital mortality in hospitalized COVID-19 patients with underlying cardiovascular risk factors.

Limitations

Retrospective study design with missing baseline characteristics
Possible overlooked NOAF incidence during hospitalization
Date of NOAF onset was not collected, preventing assessment of the duration between NOAF and in-hospital events
Potential immortal time bias regarding the association between NOAF incidence and outcomes
Cohort was from the first wave of the COVID-19 pandemic (Jan-May 2020), excluding mutant virus strains and newer established treatments
Cohort did not include individuals with COVID-19 that have a mutation of virus strains (first wave only)
Unclear whether the effect of NOAF on outcomes is comparable in the population after 2021 given new treatment options

Implication

New-onset AF warrants vigilance for mortality risk; leaves open causality and need for prospective trials.

Abstract

BACKGROUND: Both pre-existing atrial fibrillation (AF) and new-onset AF (NOAF) are observed in patients with coronavirus disease 2019 (COVID-19); however, the effect of AF on clinical outcomes is unclear. This study aimed to investigate the effect of AF, especially NOAF, on the outcomes of hospitalized patients with COVID-19. METHODS AND RESULTS: This study analyzed 673 COVID-19 patients with cardiovascular diseases and risk factors (CVDRF). Patients were divided into 3 groups; pre-existing AF (n=55), NOAF (n=28), and sinus rhythm (SR) (n=590). The baseline characteristics and in-hospital outcomes were evaluated. The mean age of the patients was 68 years, 65.4% were male, and the in-hospital mortality rate was 15.6%. The NOAF group demonstrated a higher in-hospital mortality rate (42.9%) than the pre-existing AF (30.9%) and SR (11.2%) groups (P<0.001). Patients with NOAF had a higher incidence of acute respiratory syndrome, multiple organ disease, hemorrhage, and stroke than those with pre-existing AF and NOAF. NOAF was independently associated with in-hospital mortality after adjusting for pre-existing AF and 4C mortality score (odds ratio [95% confidence interval]: 4.71 [1.63-13.6], P<0.001). CONCLUSIONS: Patients with NOAF had significantly worse outcomes as compared to patients with pre-existing AF and SR. The incidence of NOAF would be a useful predictor of clinical outcomes during hospitalization.

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Cite This Study

A 2022 study conducted a cohort in COVID-19 with cardiovascular diseases and risk factors (n=673). New-onset atrial fibrillation (NOAF) vs. Pre-existing atrial fibrillation and sinus rhythm was evaluated on In-hospital mortality (OR 4.71, 95% CI 1.63-13.6, p=<0.001). New-onset atrial fibrillation was independently associated with a significantly higher risk of in-hospital mortality (OR 4.71) compared to pre-existing atrial fibrillation and sinus rhythm.

synapsesocial.com/papers/6a9012e1b9451609c833c569 https://doi.org/10.1253/circj.cj-21-0911