tetano
Editor, Senior Moderator
Europace
. 2021 Jul 23;euab146.
doi: 10.1093/europace/euab146. Online ahead of print.
Implications of atrial fibrillation on the clinical course and outcomes of hospitalized COVID-19 patients: results of the Cardio-COVID-Italy multicentre study
Sara Paris[SUP] 1 [/SUP], Riccardo M Inciardi[SUP] 1 [/SUP], Carlo Mario Lombardi[SUP] 1 [/SUP], Daniela Tomasoni[SUP] 1 [/SUP], Pietro Ameri[SUP] 2 [/SUP], Valentina Carubelli[SUP] 1 [/SUP], Piergiuseppe Agostoni[SUP] 3 [/SUP], Claudia Canale[SUP] 2 [/SUP], Stefano Carugo[SUP] 4 [/SUP], Giambattista Danzi[SUP] 5 [/SUP], Mattia Di Pasquale[SUP] 1 [/SUP], Filippo Sarullo[SUP] 6 [/SUP], Maria Teresa La Rovere[SUP] 7 [/SUP], Andrea Mortara[SUP] 8 [/SUP], Massimo Piepoli[SUP] 9 10 [/SUP], Italo Porto[SUP] 2 [/SUP], Gianfranco Sinagra[SUP] 11 [/SUP], Maurizio Volterrani[SUP] 12 [/SUP], Massimiliano Gnecchi[SUP] 13 [/SUP], Sergio Leonardi[SUP] 13 [/SUP], Marco Merlo[SUP] 11 [/SUP], Annamaria Iorio[SUP] 14 [/SUP], Stefano Giovinazzo[SUP] 2 [/SUP], Antonio Bellasi[SUP] 15 [/SUP], Gregorio Zaccone[SUP] 1 [/SUP], Rita Camporotondo[SUP] 13 [/SUP], Francesco Catagnano[SUP] 8 13 [/SUP], Laura Dalla Vecchia[SUP] 16 [/SUP], Gloria Maccagni[SUP] 5 [/SUP], Massimo Mapelli[SUP] 3 [/SUP], Davide Margonato[SUP] 8 16 [/SUP], Luca Monzo[SUP] 17 [/SUP], Vincenzo Nuzzi[SUP] 1 [/SUP], Andrea Pozzi[SUP] 14 [/SUP], Giovanni Provenzale[SUP] 4 [/SUP], Claudia Specchia[SUP] 1 [/SUP], Chiara Tedino[SUP] 1 [/SUP], Marco Guazzi[SUP] 18 [/SUP], Michele Senni[SUP] 14 [/SUP], Marco Metra[SUP] 1 [/SUP]
Affiliations
Abstract
Aims: To assess the clinical relevance of a history of atrial fibrillation (AF) in hospitalized patients with coronavirus disease 2019 (COVID-19).
Methods and results: We enrolled 696 consecutive patients (mean age 67.4 ± 13.2 years, 69.7% males) admitted for COVID-19 in 13 Italian cardiology centres between 1 March and 9 April 2020. One hundred and six patients (15%) had a history of AF and the median hospitalization length was 14 days (interquartile range 9-24). Patients with a history of AF were older and with a higher burden of cardiovascular risk factors. Compared to patients without AF, they showed a higher rate of in-hospital death (38.7% vs. 20.8%; P < 0.001). History of AF was associated with an increased risk of death after adjustment for clinical confounders related to COVID-19 severity and cardiovascular comorbidities, including history of heart failure (HF) and increased plasma troponin [adjusted hazard ratio (HR): 1.73; 95% confidence interval (CI) 1.06-2.84; P = 0.029]. Patients with a history of AF also had more in-hospital clinical events including new-onset AF (36.8% vs. 7.9%; P < 0.001), acute HF (25.3% vs. 6.3%; P < 0.001), and multiorgan failure (13.9% vs. 5.8%; P = 0.010). The association between AF and worse outcome was not modified by previous or concomitant use of anticoagulants or steroid therapy (P for interaction >0.05 for both) and was not related to stroke or bleeding events.
Conclusion: Among hospitalized patients with COVID-19, a history of AF contributes to worse clinical course with a higher mortality and in-hospital events including new-onset AF, acute HF, and multiorgan failure. The mortality risk remains significant after adjustment for variables associated with COVID-19 severity and comorbidities.
Keywords: Atrial fibrillation; Coronavirus disease 2019; Outcome; Severe acute respiratory syndrome coronavirus-2 infection.
. 2021 Jul 23;euab146.
doi: 10.1093/europace/euab146. Online ahead of print.
Implications of atrial fibrillation on the clinical course and outcomes of hospitalized COVID-19 patients: results of the Cardio-COVID-Italy multicentre study
Sara Paris[SUP] 1 [/SUP], Riccardo M Inciardi[SUP] 1 [/SUP], Carlo Mario Lombardi[SUP] 1 [/SUP], Daniela Tomasoni[SUP] 1 [/SUP], Pietro Ameri[SUP] 2 [/SUP], Valentina Carubelli[SUP] 1 [/SUP], Piergiuseppe Agostoni[SUP] 3 [/SUP], Claudia Canale[SUP] 2 [/SUP], Stefano Carugo[SUP] 4 [/SUP], Giambattista Danzi[SUP] 5 [/SUP], Mattia Di Pasquale[SUP] 1 [/SUP], Filippo Sarullo[SUP] 6 [/SUP], Maria Teresa La Rovere[SUP] 7 [/SUP], Andrea Mortara[SUP] 8 [/SUP], Massimo Piepoli[SUP] 9 10 [/SUP], Italo Porto[SUP] 2 [/SUP], Gianfranco Sinagra[SUP] 11 [/SUP], Maurizio Volterrani[SUP] 12 [/SUP], Massimiliano Gnecchi[SUP] 13 [/SUP], Sergio Leonardi[SUP] 13 [/SUP], Marco Merlo[SUP] 11 [/SUP], Annamaria Iorio[SUP] 14 [/SUP], Stefano Giovinazzo[SUP] 2 [/SUP], Antonio Bellasi[SUP] 15 [/SUP], Gregorio Zaccone[SUP] 1 [/SUP], Rita Camporotondo[SUP] 13 [/SUP], Francesco Catagnano[SUP] 8 13 [/SUP], Laura Dalla Vecchia[SUP] 16 [/SUP], Gloria Maccagni[SUP] 5 [/SUP], Massimo Mapelli[SUP] 3 [/SUP], Davide Margonato[SUP] 8 16 [/SUP], Luca Monzo[SUP] 17 [/SUP], Vincenzo Nuzzi[SUP] 1 [/SUP], Andrea Pozzi[SUP] 14 [/SUP], Giovanni Provenzale[SUP] 4 [/SUP], Claudia Specchia[SUP] 1 [/SUP], Chiara Tedino[SUP] 1 [/SUP], Marco Guazzi[SUP] 18 [/SUP], Michele Senni[SUP] 14 [/SUP], Marco Metra[SUP] 1 [/SUP]
Affiliations
- PMID: 34297833
- DOI: 10.1093/europace/euab146
Abstract
Aims: To assess the clinical relevance of a history of atrial fibrillation (AF) in hospitalized patients with coronavirus disease 2019 (COVID-19).
Methods and results: We enrolled 696 consecutive patients (mean age 67.4 ± 13.2 years, 69.7% males) admitted for COVID-19 in 13 Italian cardiology centres between 1 March and 9 April 2020. One hundred and six patients (15%) had a history of AF and the median hospitalization length was 14 days (interquartile range 9-24). Patients with a history of AF were older and with a higher burden of cardiovascular risk factors. Compared to patients without AF, they showed a higher rate of in-hospital death (38.7% vs. 20.8%; P < 0.001). History of AF was associated with an increased risk of death after adjustment for clinical confounders related to COVID-19 severity and cardiovascular comorbidities, including history of heart failure (HF) and increased plasma troponin [adjusted hazard ratio (HR): 1.73; 95% confidence interval (CI) 1.06-2.84; P = 0.029]. Patients with a history of AF also had more in-hospital clinical events including new-onset AF (36.8% vs. 7.9%; P < 0.001), acute HF (25.3% vs. 6.3%; P < 0.001), and multiorgan failure (13.9% vs. 5.8%; P = 0.010). The association between AF and worse outcome was not modified by previous or concomitant use of anticoagulants or steroid therapy (P for interaction >0.05 for both) and was not related to stroke or bleeding events.
Conclusion: Among hospitalized patients with COVID-19, a history of AF contributes to worse clinical course with a higher mortality and in-hospital events including new-onset AF, acute HF, and multiorgan failure. The mortality risk remains significant after adjustment for variables associated with COVID-19 severity and comorbidities.
Keywords: Atrial fibrillation; Coronavirus disease 2019; Outcome; Severe acute respiratory syndrome coronavirus-2 infection.