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Meta-Analysis
. 2022;29(1):33-43.
doi: 10.5603/CJ.a2021.0167. Epub 2021 Dec 13.

Outcomes and mortality associated with atrial arrhythmias among patients hospitalized with COVID-19: A systematic review and meta-analysis

Lukasz Szarpak  1   2   3 , Krzysztof J Filipiak  4 , Aleksandra Skwarek  5 , Michal Pruc  6 , Mansur Rahnama  7 , Andrea Denegri  8 , Marta Jachowicz  9 , Malgorzata Dawidowska  10 , Aleksandra Gasecka  4 , Milosz J Jaguszewski  11 , Lukasz Iskrzycki  12 , Zubaid Rafique  13
Affiliations
Meta-Analysis

Outcomes and mortality associated with atrial arrhythmias among patients hospitalized with COVID-19: A systematic review and meta-analysis

Lukasz Szarpak et al. Cardiol J. 2022.

Abstract

Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia in the adult population. Herein, is a systematic review with meta-analysis to determine the impact of AF/atrial flutter (AFL) on mortality, as well as individual complications in patients hospitalized with the coronavirus disease 2019 (COVID-19).

Methods: A systematic search of the SCOPUS, Medline, Web of Science, CINAHL and Cochrane databases was performed. The a priori primary outcome of interest was in-hospital mortality. A random-effects model was used to pool study results.

Results: Nineteen studies which included 33,296 patients were involved in this meta-analysis. Inhospital mortality for AF/AFL vs. no-AF/AFL groups varied and amounted to 32.8% vs. 14.2%, respectively (risk ratio [RR]: 2.18; 95% confidence interval [CI]: 1.79-2.65; p < 0.001). In-hospital mortality in new onset AF/AFL compared to no-AFAFL was 22.0% vs. 18.8% (RR: 1.86; 95% CI: 1.54-2.24; p < 0.001). Intensive care unit (ICU) admission was required for 17.7% of patients with AF/AFL compared to 10.8% for patients without AF/AFL (RR: 1.94; 95% CI: 1.04-3.62; p = 0.04).

Conclusions: The present study reveals that AF/AFL is associated with increased in-hospital mortality and worse outcomes in patients with COVID-19 and may be used as a negative prognostic factor in these patients. Patients with AF/AFL are at higher risk of hospitalization in ICU. The presence of AF/AFL in individuals with COVID-19 is associated with higher risk of complications, such as bleeding, acute kidney injury and heart failure. AF/AFL may be associated with unfavorable outcomes due to the hemodynamic compromise of cardiac function itself or hyperinflammatory state typical of these conditions.

Keywords: COVID-19; atrial fibrillation; atrial flutter; meta-analysis; new onset atrial fibrillation; outcome; systematic review.

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Conflict of interest statement

Conflict of interest: None declared

Figures

Figure 1
Figure 1
Flow diagram showing stages of the database search and study selection as per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
Figure 2
Figure 2
Forest plot of in-hospital mortality in atrial fibrillation/atrial flutter (AF/AFL) and no-AF/AFL groups. The center of each square represents the weighted risk ratios for individual trials, and the corresponding horizontal line stands for a 95% confidence interval (CI). The diamonds represent pooled results.
Figure 3
Figure 3
Forest plot of in-hospital mortality in new onset atrial fibrillation/atrial flutter (AF/AFL) no-AF/AFL groups. The center of each square represents the weighted risk ratios for individual trials, and the corresponding horizontal line stands for a 95% confidence interval (CI). The diamonds represent pooled results.
Figure 4
Figure 4
Forest plot of length of hospital stay in atrial fibrillation/atrial flutter (AF/AFL) and no-AF/AFL groups. The center of each square represents the weighted standard mean differences for individual trials, and the corresponding horizontal line stands for a 95% confidence interval (CI). The diamonds represent pooled results; ICU — intensive care unit.
See this image and copyright information in PMC

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