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. 2024 Feb;47(2):e24240.
doi: 10.1002/clc.24240.

The incidence and impact of atrial fibrillation on hospitalized Coronavirus disease-2019 patients

Haiming Niu  1 , Jianwei Li  1 , Catherine Teng  2 , Xiaojia Lu  3 , Chengyue Jin  4 , Peng Cai  5 , Ao Shi  6 , Xiaoqing Shen  1 , Qiqi Chen  1 , Miaolian Chen  1 , Yong Yuan  7 , Pengyang Li  8
Affiliations

The incidence and impact of atrial fibrillation on hospitalized Coronavirus disease-2019 patients

Haiming Niu et al. Clin Cardiol. 2024 Feb.

Abstract

Background: Since 2019, Coronavirus disease-2019 (COVID-19) has raised unprecedented global health crisis. The incidence and impact of atrial fibrillation (AF) on patients with COVID-19 remain unclearly defined.

Methods: We conducted a retrospective cohort study using ICD-10 codes to identify patients with a primary diagnosis of COVID-19 with or without AF in National Inpatient Sample Database 2020. We compared the outcome of COVID-19 patients with a concurrent diagnosis of AF with those without.

Hypothesis: AF will adversely affect the prognosis of hospitalized COVID-19 patients.

Results: A total of 211 619 patients with a primary diagnosis of COVID-19 were identified. Among these patients, 31 923 (15.08%) had a secondary diagnosis of AF. Before propensity score matching, COVID-AF cohort was older (75.8 vs. 62.2-year-old, p < .001) and had more men (57.5% vs. 52.0%, p < .001). It is associated with more comorbidities, mainly including diabetes mellitus (43.7% vs. 39.9%, p < .001), hyperlipidemia (54.6% vs. 39.8%, p < .001), chronic kidney disease (34.5% vs. 17.0%, p < .001), coronary artery disease (35.3% vs. 14.4%, p < .001), anemia (27.8% vs. 18.6%, p < .001), and cancer (4.8% vs. 3.4%, p < .001). After performing propensity score match, a total of 31 862 patients were matched within each group. COVID-AF cohort had higher inpatient mortality (22.2% vs. 15.3%, p < .001) and more complications, mainly including cardiac arrest (3.9% vs. 2.3%, p < .001), cardiogenic shock (0.9% vs. 0.3%, p < .001), hemorrhagic stroke (0.4% vs. 0.3%, p = .025), and ischemic stroke (1.3% vs. 0.7%, p < .001). COVID-AF cohort was more costly, with a longer length of stay, and a higher total charge.

Conclusion: AF is common in patients hospitalized for COVID-19, and is associated with poorer in-hospital mortality, immediate complications and increased healthcare resource utilization.

Keywords: COVID-19; atrial fibrillation; in-hospital complication; mortality.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Standardized mean differences of covariates before and after propensity score matching between COVID‐19 patients with and without atrial fibrillation. Standardized mean difference was used to examine the balance of the covariate distribution between the matched atrial fibrillation and the nonatrial fibrillation groups. All standardized mean differences of covariate distributions in this study were less than .1, which was considered balanced. CAD, coronary artery disease; CKD indicates chronic kidney disease; COPD, chronic obstructive pulmonary disease; COVID‐19, Coronavirus disease‐2019; OSA, obstructive sleep apnea.
Figure 2
Figure 2
Forest plot graph showing adjusted odds ratio for in‐hospital outcomes after propensity score matching. AF, atrial fibrillation; AKI, acute kidney injury; ARF, acute respiratory failure.
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