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. 2020 Dec 11;37(1):231-237.
doi: 10.1002/joa3.12458. eCollection 2021 Feb.

Atrial fibrillation and the risk of 30-day incident thromboembolic events, and mortality in adults ≥ 50 years with COVID-19

Stephanie L Harrison  1   2 , Elnara Fazio-Eynullayeva  3 , Deirdre A Lane  1   2   4 , Paula Underhill  5 , Gregory Y H Lip  1   2   4
Affiliations

Atrial fibrillation and the risk of 30-day incident thromboembolic events, and mortality in adults ≥ 50 years with COVID-19

Stephanie L Harrison et al. J Arrhythm. .

Abstract

Background: There are limited data on the outcomes of adults with coronavirus disease 2019 (COVID-19) and atrial fibrillation (AF). The objectives were to (i) examine associations between AF, 30-day thromboembolic events and mortality in adults with COVID-19 and (ii) examine associations between COVID-19, 30-day thromboembolic events and mortality in adults with AF.

Methods: A study was conducted using a global federated health research network. Adults aged ≥50 years who presented to 41 participating healthcare organizations between 20 January 2020 and 1 September 2020 with COVID-19 were included.

Results: For the first objective, 6589 adults with COVID-19 and AF were propensity score matched for age, gender, race, and comorbidities to 6589 adults with COVID-19 without AF. The survival probability was significantly lower in adults with COVID-19 and AF compared to matched adults without AF (82.7% compared to 88.3%, Log-Rank test P < .0001; Risk Ratio (95% confidence interval) 1.61 (1.46, 1.78)) and risk of thromboembolic events was higher in patients with AF (9.9% vs 7.0%, Log-Rank test P < .0001; Risk Ratio (95% confidence interval) 1.41 (1.26, 1.59)). For the second objective, 2454 adults with AF and COVID-19 were propensity score matched to 2454 adults with AF without COVID-19. The survival probability was significantly lower for adults with AF and COVID-19 compared to adults with AF without COVID-19, but there was no significant difference in risk of thromboembolic events.

Conclusions: AF could be an important risk factor for short-term mortality with COVID-19, and COVID-19 may increase risk of short-term mortality amongst adults with AF.

Keywords: COVID‐19; atrial fibrillation; coronavirus‐2019; mortality; thromboembolic events.

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Conflict of interest statement

Stephanie L Harrison: None declared. Elnara Fazio‐Eynullayeva and Paula Underhill are employees of TriNetX Inc Deirdre A Lane has received investigator‐initiated educational grants from Bristol‐Myers Squibb (BMS), has been a speaker for Boehringer Ingeheim and BMS/Pfizer, and has consulted for BMS, Boehringer Ingelheim, and Daiichi‐Sankyo. Gregory Lip: consultant for Bayer/Janssen, BMS/Pfizer, Medtronic, Boehringer Ingelheim, Novartis, Verseon, and Daiichi‐Sankyo and speaker for Bayer, BMS/Pfizer, Medtronic, Boehringer Ingelheim, and Daiichi‐Sankyo. No fees are directly received to Gregory Lip personally.

Figures

FIGURE 1
FIGURE 1
Kaplan‐Meier survival curve of 30‐day mortality for patients aged ≥ 50 years with COVID‐19 with and without history of AF after propensity score matching. AF: Atrial fibrillation. Propensity score matched for age, gender, race, and history of hypertensive diseases, ischemic heart diseases, heart failure, cerebrovascular diseases, diabetes mellitus, chronic kidney disease, diseases of the respiratory system, diseases of the digestive system, diseases of the nervous system, and neoplasms. Log‐Rank test: P < .0001
FIGURE 2
FIGURE 2
Kaplan‐Meier survival curve of 30‐day mortality for patients aged ≥ 50 years with AF and COVID‐19 and historical controls with AF without COVID‐19 after propensity score matching. AF: Atrial fibrillation. Propensity score matched for age, gender, race, and history of hypertensive diseases, ischemic heart diseases, heart failure, cerebrovascular diseases, diabetes mellitus, chronic kidney disease, diseases of the respiratory system, diseases of the digestive system, diseases of the nervous system, and neoplasms. Log‐Rank test: P < .0001
See this image and copyright information in PMC

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