Prevalence and outcomes of atrial fibrillation in patients hospitalized with COVID-19

Abstract

Objective: Atrial fibrillation (AF) is a common arrhythmia in patients at high cardiovascular risk. COVID-19 patients with underlying cardiovascular disease are at increased risk of poor clinical outcomes. In this study, we aimed to determine hospital outcomes among patients admitted with AF and COVID -19 infection.

Methods: We conducted a retrospective analysis using the 2020 California State Inpatient data, including all COVID-19 hospitalizations of individuals aged ≥18. Primary outcomes were in-hospital mortality, prolonged length of stay (above the 75^th percentile), vasopressor use, mechanical ventilation, and ICU admission. We compared adverse hospital outcomes between those with and without AF and used multivariable logistic regression to adjust for confounders.

Results: This analysis included 94,114 COVID-19 hospitalizations, of which 9,391 (10.0%) had AF. Patients with COVID-19 and AF had higher rates of adverse outcomes, including mortality (27.2% versus 9.6%, P < 0.001), prolonged length of stay (40.0% versus 27.1%, P < 0.001), vasopressor use (4.4% versus 1.9%, P < 0.001), mechanical ventilation (19.0% versus 9.1%, P < 0.001), and ICU admission (18.4% versus 8.8%, P < 0.001) After multivariable adjustment, the odds of adverse outcomes remained significantly higher, including mortality (aOR, 2.04, 95% CI: 1.92-2.16), prolonged length of stay (aOR, 1.37, 95% CI: 1.31-1.44), vasopressor use (aOR, 1.98, 95% CI: 1.86-2.11), mechanical ventilation (aOR, 1.95, 95% CI: 1.72-2.20), and ICU admission (aOR, 2.01, 95% CI: 1.88-2.15).

Conclusion: COVID -19 hospitalized patients frequently have underlying AF, which confers a higher risk of adverse hospital outcomes and mortality, even after adjusting for baseline comorbidities. Heightened awareness is needed in the treatment of hospitalized COVID-19 patients with AF.

Plain Language Summary

Atrial fibrillation (AF) is a common heart rhythm disorder, especially in patients with high cardiovascular risk. This study aimed to investigate the hospital outcomes for patients admitted with both AF and COVID-19. We used data from the California State Inpatient Database for the year 2020, focusing on COVID-19 hospitalizations of adults aged 18 and older. The main outcomes studied were in-hospital death, extended hospital stays, use of vasopressor medications that raise blood pressure, need for mechanical ventilation, and admission to the intensive care unit (ICU). Our results showed that patients with both COVID-19 and AF had significantly worse outcomes compared to those without AF. Specifically, these patients had higher rates of death, extended hospital stays, vasopressor medication use, mechanical ventilation, and ICU admission, even after accounting for other health conditions. The study concludes that hospitalized COVID-19 patients with underlying AF are at a greater risk for severe complications and death. This highlights the need for increased attention and care for COVID-19 patients with AF to improve their hospital outcomes.

Keywords:

• atrial fibrillation
• COVID-19
• mortality
• length of stay
• vasopressor use
• mechanical ventilation
• ICU admission

Disclaimer

As a service to authors and researchers we are providing this version of an accepted manuscript (AM). Copyediting, typesetting, and review of the resulting proofs will be undertaken on this manuscript before final publication of the Version of Record (VoR). During production and pre-press, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal relate to these versions also.