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. 2021 Apr;18(4):501-507.
doi: 10.1016/j.hrthm.2021.01.018. Epub 2021 Jan 22.

Atrial fibrillation is an independent predictor for in-hospital mortality in patients admitted with SARS-CoV-2 infection

Stavros E Mountantonakis  1 , Moussa Saleh  2 , Joanna Fishbein  3 , Amir Gandomi  4 , Martin Lesser  3 , John Chelico  3 , James Gabriels  2 , Michael Qiu  4 , Laurence M Epstein  2 ; Northwell COVID-19 Research Consortium
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Atrial fibrillation is an independent predictor for in-hospital mortality in patients admitted with SARS-CoV-2 infection

Stavros E Mountantonakis et al. Heart Rhythm. 2021 Apr.

Abstract

Background: Atrial fibrillation (AF) is the most encountered arrhythmia and has been associated with worse in-hospital outcomes.

Objective: This study was to determine the incidence of AF in patients hospitalized with coronavirus disease 2019 (COVID-19) as well as its impact on in-hospital mortality.

Methods: Patients hospitalized with a positive COVID-19 polymerase chain reaction test between March 1 and April 27, 2020, were identified from the common medical record system of 13 Northwell Health hospitals. Natural language processing search algorithms were used to identify and classify AF. Patients were classified as having AF or not. AF was further classified as new-onset AF vs history of AF.

Results: AF occurred in 1687 of 9564 patients (17.6%). Of those, 1109 patients (65.7%) had new-onset AF. Propensity score matching of 1238 pairs of patients with AF and without AF showed higher in-hospital mortality in the AF group (54.3% vs 37.2%; P < .0001). Within the AF group, propensity score matching of 500 pairs showed higher in-hospital mortality in patients with new-onset AF as compared with those with a history of AF (55.2% vs 46.8%; P = .009). The risk ratio of in-hospital mortality for new-onset AF in patients with sinus rhythm was 1.56 (95% confidence interval 1.42-1.71; P < .0001). The presence of cardiac disease was not associated with a higher risk of in-hospital mortality in patients with AF (P = .1).

Conclusion: In patients hospitalized with COVID-19, 17.6% experienced AF. AF, particularly new-onset, was an independent predictor of in-hospital mortality.

Keywords: Atrial fibrillation; COVID-19; Mortality; Pandemic; SARS-CoV-2.

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Figures

Figure 1
Figure 1
Flow diagram of the cohort selection. COVID-19 = coronavirus disease 2019; EKG = electrocardiogram; PCR = polymerase chain reaction.
Figure 2
Figure 2
Relative risk ratios of in-hospital mortality. The plot provides risk ratios along with corresponding 95% confidence intervals for 4 separate analyses. Each risk ratio should be interpreted independently and not directly compared across all 4. AF = atrial fibrillation.
See this image and copyright information in PMC

Comment in

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