Long-Term Mortality after New-Onset Atrial Fibrillation in COVID-19

Abstract

Background: Atrial fibrillation (AF) has been described as a common cardiovascular manifestation in patients suffering from coronavirus disease 2019 (COVID-19) and has been suggested to be a potential risk factor for a poor clinical outcome. Methods: In this observational study, all patients hospitalized due to COVID-19 in 2020 in the Cantonal Hospital of Baden were included. We assessed clinical characteristics, in-hospital outcomes as well as long-term outcomes with a mean follow-up time of 278 (±90) days. Results: Amongst 646 patients diagnosed with COVID-19 (59% male, median age: 70 (IQR: 59-80)) in 2020, a total of 177 (27.4%) patients were transferred to the intermediate/intensive care unit (IMC/ICU), and 76 (11.8%) were invasively ventilated during their hospitalization. Ninety patients (13.9%) died. A total of 116 patients (18%) showed AF on admission of which 34 (29%) had new-onset AF. Patients with COVID-19 and newly diagnosed AF were more likely to require invasive ventilation (OR: 3.5; p = 0.01) but did not encounter an increased in-hospital mortality. Moreover, AF neither increased long-term mortality nor the number of rehospitalizations during follow-up after adjusting for confounders. Conclusions: In patients suffering from COVID-19, the new-onset of AF on admission was associated with an increased risk of invasive ventilation and transfer to the IMC/ICU but did not affect in-hospital or long-term mortality.

Keywords: COVID-19; atrial fibrillation; outcome.

Figure 1

Forest plots of the primary outcome “Invasive Ventilation”. The risk of invasive ventilation was assessed by means of sequential logistic models with a stepwise reduction based on the Aikake information criterion. Abbreviations: ACE = angiotensin-converting enzyme; AF = atrial fibrillation; BMI = body mass index; sO₂ = oxygen saturation; FiO₂ = fraction of inspired oxygen; COVID-19 = coronavirus disease 2019.

Figure 2

Forest plots of the primary outcome “In-Hospital Death”. The transfer risk for in-hospital death was assessed by sequential logistic models with a stepwise reduction based on the Aikake information criterion. Abbreviations: ACE = angiotensin-converting enzyme, AF = atrial fibrillation, BMI = body mass index, sO₂ = oxygen saturation, FiO₂ = fraction of inspired oxygen, COVID-19 = coronavirus disease 2019.

Figure 3

Forest plots of the secondary outcome “Repeated Hospitalization”. The transfer risk for repeated hospitalization was assessed by sequential logistic models with a stepwise reduction based on the Aikake information criterion. Abbreviations: ACE = angiotensin-converting enzyme; AF = atrial fibrillation; BMI = body mass index; sO₂ = oxygen saturation; FiO₂ = fraction of inspired oxygen; COVID-19 = coronavirus disease 2019.

Figure 4

Forest plots of the secondary outcome “Long-Term Mortality”. The transfer risk for long-term mortality was assessed by sequential logistic models with a stepwise reduction based on the Aikake information criterion. Abbreviations: ACE = angiotensin-converting enzyme; AF = atrial fibrillation; BMI = body mass index; sO₂ = oxygen saturation; FiO₂ = fraction of inspired oxygen; COVID-19 = coronavirus disease 2019.

Figure 5

Kaplan–Meier survival curve for “In-Hospital Death” in patients with COVID-19 with and without atrial fibrillation. Abbreviations: AF = atrial fibrillation.

Figure 6

Kaplan–Meier survival curve for “Long-Term Mortality” in patients with COVID-19 with no atrial fibrillation and newly diagnosed atrial fibrillation. Abbreviations: AF = atrial fibrillation.