Key result
Arrhythmia during COVID-19 hospitalization linked to ~40-fold higher in-hospital mortality.
Why the study?
Cardiac involvement and rhythm disorders are common in COVID-19, but the association of comorbidities and QT dispersion with arrhythmias and outcomes required evaluation.
Observational (n=200)
No
Odds Ratio: 39.66 (95% CI 5.2–302.51)
Absolute Event Rate: 25% vs 0.8%
p-value: p=0.0004
Arrhythmias in hospitalized COVID-19 patients are independently associated with age, coronary artery disease, and elevated troponin, and confer a nearly 40-fold higher risk of in-hospital mortality.
May inform arrhythmia monitoring in COVID-19; leaves open whether comorbidities or QT dispersion warrant targeted interventions.
Background The heart is commonly involved in COVID-19, and rhythm disorders have been largely reported. Objective To evaluate the association of some non-cardiac and cardiac comorbidities and QT dispersion with arrhythmias and their impact on outcomes in hospitalized patients with COVID-19. Methods Each patient underwent cardiac telemetry monitoring through the entire hospitalization period, laboratory analyses, 12-lead ECG, and lung imaging examination. Patients with arrhythmia were divided into three groups (bradyarrhythmias, tachyarrhythmias, and tachy- and bradyarrhythmias). Results Two-hundred patients completed the study (males, 123; mean age, 70.1 years); of these, 80 patients (40%) exhibited rhythm disorders on telemetry. Patients with arrhythmia were older (p < 0.0001), had a greater number of comorbidities (p < 0.0001), higher values of creatinine (p = 0.007), B-type natriuretic peptide (p < 0.0001), troponin (p < 0.0001), C-reactive protein (p = 0.01), ferritin (p = 0.001), D-dimer (p < 0.0001), procalcitonin (p = 0.0008), QT interval (p = 0.002), QTc interval (p = 0.04), and QTc dispersion (p = 0.01), and lower values of sodium (p = 0.03), magnesium (p = 0.04), glomerular filtration rate (p < 0.0001), and hemoglobin (p = 0.008) as compared to patients without arrhythmia. By comparing the three subgroups of patients, no significant differences were found. At multivariate analysis, age [odds ratio (OR) = 1.14 (95% CI: 1.07–1.22); p = 0.0004], coronary artery disease [OR = 12.7 (95% CI: 2.38–68.01); p = 0.005], and circulating troponin [OR = 1.05 (95% CI: 1.003–1.10); p = 0.04] represented risk factors independently associated with arrhythmia. All-cause in-hospital mortality was ∼40-fold higher among patients with arrhythmia [OR = 39.66 (95% CI: 5.20–302.51); p = 0.0004]. Conclusion Arrhythmias are associated with aging, coronary artery disease, subtle myocardial injury, hyperinflammatory status, coagulative unbalance, and prolonged QTc dispersion in patients with COVID-19, and confer a worse in-hospital prognosis. Given its usefulness, routinary use of cardiac telemetry should be encouraged in COVID wards.
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Cozzolino et al. (2022) conducted an observational in COVID-19 (n=200). Arrhythmia vs. No arrhythmia was evaluated on All-cause in-hospital mortality (OR 39.66, 95% CI 5.20-302.51, p=0.0004). Arrhythmia during hospitalization for COVID-19 was associated with a nearly 40-fold higher risk of all-cause in-hospital mortality (OR 39.66) compared to patients without arrhythmia.
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