Atrial Fibrillation and In-Hospital Mortality in Covid-19 patients

Irum D. Kotadia; Maria Dias; Caroline  Roney; Richard A Parker; Robert O'Dowling; Neil Bodagh; José-Alonso  Lemus-Solis; Daniel  O’Hare; Iain Sim; David E Newby; Steven  Niederer; Jonathan  Birns; Peter  Sommerville; Ajay Bhalla; Mark  O’Neill; Steven Williams

doi:10.1016/j.hroo.2023.10.004

Atrial Fibrillation and In-Hospital Mortality in Covid-19 patients

Irum D. Kotadia^*, Maria Dias, Caroline Roney, Richard A Parker, Robert O'Dowling, Neil Bodagh, José-Alonso Lemus-Solis, Daniel O’Hare, Iain Sim, David E Newby, Steven Niederer, Jonathan Birns, Peter Sommerville, Ajay Bhalla, Mark O’Neill, Steven Williams

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

Abstract / Description of output

Background
There are conflicting data on whether new-onset AF is independently associated with poor outcomes in Covid-19 patients. This study represents the largest dataset curated by manual chart review comparing clinical outcomes between patients with sinus rhythm, pre-existing and new-onset AF.

Objective
The primary aim of this study was to assess patient outcomes in Covid-19 patients with sinus rhythm, pre-existing and new-onset AF. The secondary aim was to evaluate predictors of new-onset AF in patients with Covid-19 infection.

Methods
Single-centre retrospective study of patients with a confirmed diagnosis of Covid-19 admitted between March and September 2020. Patient demographic data, medical history and clinical outcome data were manually collected. Adjusted comparisons were performed following propensity score matching between those with pre-existing or new-onset AF and those without AF.

Results
The study population comprised of 1241 patients. 94 patients (7.6%) had pre-existing AF and 42 patients (3.4%) developed new-onset AF. New-onset AF was associated with increased in-hospital mortality before (OR: 3.58, 95% CI 1.78-7.06, p<0.005) and after (OR: 2.80, 95% CI 1.01-7.77, p<0.005) propensity score matching compared with the no AF group. However, pre-existing AF was not independently associated with in-hospital mortality compared to patients with no AF (post-matching OR: 1.13, 95% CI 0.57-2.21, p=0.732).

Conclusion
New-onset AF, but not pre-existing AF, is independently associated with elevated mortality in patients hospitalised with Covid-19. This observation highlights the need for careful monitoring of Covid-19 patients with new-onset AF. Further research is needed to explain the mechanistic relationship between new-onset AF and clinical outcomes in Covid-19 patients.

Original language	English
Journal	Heart Rhythm O2
Early online date	16 Oct 2023
DOIs	https://doi.org/10.1016/j.hroo.2023.10.004
Publication status	E-pub ahead of print - 16 Oct 2023

Keywords / Materials (for Non-textual outputs)

Covid-19
Atrial fibrillation
Covid-19 and cardiovascular complications
Covid-19 and arrhythmia
SARS-CoV-2

Access to Document

10.1016/j.hroo.2023.10.004Licence: Creative Commons: Attribution (CC-BY)

Atrial Fibrilation_KOTADIA_DOA13102023_VOR_CC-BYFinal published version, 1.15 MBLicence: Creative Commons: Attribution (CC-BY)

https://www.sciencedirect.com/science/article/pii/S2666501823002623Licence: Creative Commons: Attribution (CC-BY)

Informing atrial fibrillation rhythm control strategies using electrophysiological testing, cardiac imaging and computational modelling
Williams, S. & Newby, D.
UK-based charities
1/11/20 → 31/10/25
Project: Research

Cite this

Kotadia, I. D., Dias, M., Roney, C., Parker, R. A., O'Dowling, R., Bodagh, N., Lemus-Solis, J.-A., O’Hare, D., Sim, I., Newby, D. E., Niederer, S., Birns, J., Sommerville, P., Bhalla, A., O’Neill, M., & Williams, S. (2023). Atrial Fibrillation and In-Hospital Mortality in Covid-19 patients. Heart Rhythm O2. Advance online publication. https://doi.org/10.1016/j.hroo.2023.10.004

@article{68e5472453aa462c8ebf47bea7e2188b,

title = "Atrial Fibrillation and In-Hospital Mortality in Covid-19 patients",

abstract = "BackgroundThere are conflicting data on whether new-onset AF is independently associated with poor outcomes in Covid-19 patients. This study represents the largest dataset curated by manual chart review comparing clinical outcomes between patients with sinus rhythm, pre-existing and new-onset AF.ObjectiveThe primary aim of this study was to assess patient outcomes in Covid-19 patients with sinus rhythm, pre-existing and new-onset AF. The secondary aim was to evaluate predictors of new-onset AF in patients with Covid-19 infection.MethodsSingle-centre retrospective study of patients with a confirmed diagnosis of Covid-19 admitted between March and September 2020. Patient demographic data, medical history and clinical outcome data were manually collected. Adjusted comparisons were performed following propensity score matching between those with pre-existing or new-onset AF and those without AF.ResultsThe study population comprised of 1241 patients. 94 patients (7.6%) had pre-existing AF and 42 patients (3.4%) developed new-onset AF. New-onset AF was associated with increased in-hospital mortality before (OR: 3.58, 95% CI 1.78-7.06, p<0.005) and after (OR: 2.80, 95% CI 1.01-7.77, p<0.005) propensity score matching compared with the no AF group. However, pre-existing AF was not independently associated with in-hospital mortality compared to patients with no AF (post-matching OR: 1.13, 95% CI 0.57-2.21, p=0.732).ConclusionNew-onset AF, but not pre-existing AF, is independently associated with elevated mortality in patients hospitalised with Covid-19. This observation highlights the need for careful monitoring of Covid-19 patients with new-onset AF. Further research is needed to explain the mechanistic relationship between new-onset AF and clinical outcomes in Covid-19 patients.",

keywords = "Covid-19, Atrial fibrillation, Covid-19 and cardiovascular complications, Covid-19 and arrhythmia, SARS-CoV-2",

author = "Kotadia, {Irum D.} and Maria Dias and Caroline Roney and Parker, {Richard A} and Robert O'Dowling and Neil Bodagh and Jos{\'e}-Alonso Lemus-Solis and Daniel O{\textquoteright}Hare and Iain Sim and Newby, {David E} and Steven Niederer and Jonathan Birns and Peter Sommerville and Ajay Bhalla and Mark O{\textquoteright}Neill and Steven Williams",

note = "This study was supported by the Wellcome/EPSRC Centre for Medical Engineering [WT 203148/Z/16/Z]. IK acknowledges support from the British Heart Foundation (FS/CRTF/21/24166). SW acknowledges support from the British Heart Foundation (FS/20/26/34952).",

year = "2023",

month = oct,

day = "16",

doi = "10.1016/j.hroo.2023.10.004",

language = "English",

journal = "Heart Rhythm O2",

issn = "2666-5018",

publisher = "Elsevier",

}

TY - JOUR

T1 - Atrial Fibrillation and In-Hospital Mortality in Covid-19 patients

AU - Kotadia, Irum D.

AU - Dias, Maria

AU - Roney, Caroline

AU - Parker, Richard A

AU - O'Dowling, Robert

AU - Bodagh, Neil

AU - Lemus-Solis, José-Alonso

AU - O’Hare, Daniel

AU - Sim, Iain

AU - Newby, David E

AU - Niederer, Steven

AU - Birns, Jonathan

AU - Sommerville, Peter

AU - Bhalla, Ajay

AU - O’Neill, Mark

AU - Williams, Steven

N1 - This study was supported by the Wellcome/EPSRC Centre for Medical Engineering [WT 203148/Z/16/Z]. IK acknowledges support from the British Heart Foundation (FS/CRTF/21/24166). SW acknowledges support from the British Heart Foundation (FS/20/26/34952).

PY - 2023/10/16

Y1 - 2023/10/16

N2 - BackgroundThere are conflicting data on whether new-onset AF is independently associated with poor outcomes in Covid-19 patients. This study represents the largest dataset curated by manual chart review comparing clinical outcomes between patients with sinus rhythm, pre-existing and new-onset AF.ObjectiveThe primary aim of this study was to assess patient outcomes in Covid-19 patients with sinus rhythm, pre-existing and new-onset AF. The secondary aim was to evaluate predictors of new-onset AF in patients with Covid-19 infection.MethodsSingle-centre retrospective study of patients with a confirmed diagnosis of Covid-19 admitted between March and September 2020. Patient demographic data, medical history and clinical outcome data were manually collected. Adjusted comparisons were performed following propensity score matching between those with pre-existing or new-onset AF and those without AF.ResultsThe study population comprised of 1241 patients. 94 patients (7.6%) had pre-existing AF and 42 patients (3.4%) developed new-onset AF. New-onset AF was associated with increased in-hospital mortality before (OR: 3.58, 95% CI 1.78-7.06, p<0.005) and after (OR: 2.80, 95% CI 1.01-7.77, p<0.005) propensity score matching compared with the no AF group. However, pre-existing AF was not independently associated with in-hospital mortality compared to patients with no AF (post-matching OR: 1.13, 95% CI 0.57-2.21, p=0.732).ConclusionNew-onset AF, but not pre-existing AF, is independently associated with elevated mortality in patients hospitalised with Covid-19. This observation highlights the need for careful monitoring of Covid-19 patients with new-onset AF. Further research is needed to explain the mechanistic relationship between new-onset AF and clinical outcomes in Covid-19 patients.

AB - BackgroundThere are conflicting data on whether new-onset AF is independently associated with poor outcomes in Covid-19 patients. This study represents the largest dataset curated by manual chart review comparing clinical outcomes between patients with sinus rhythm, pre-existing and new-onset AF.ObjectiveThe primary aim of this study was to assess patient outcomes in Covid-19 patients with sinus rhythm, pre-existing and new-onset AF. The secondary aim was to evaluate predictors of new-onset AF in patients with Covid-19 infection.MethodsSingle-centre retrospective study of patients with a confirmed diagnosis of Covid-19 admitted between March and September 2020. Patient demographic data, medical history and clinical outcome data were manually collected. Adjusted comparisons were performed following propensity score matching between those with pre-existing or new-onset AF and those without AF.ResultsThe study population comprised of 1241 patients. 94 patients (7.6%) had pre-existing AF and 42 patients (3.4%) developed new-onset AF. New-onset AF was associated with increased in-hospital mortality before (OR: 3.58, 95% CI 1.78-7.06, p<0.005) and after (OR: 2.80, 95% CI 1.01-7.77, p<0.005) propensity score matching compared with the no AF group. However, pre-existing AF was not independently associated with in-hospital mortality compared to patients with no AF (post-matching OR: 1.13, 95% CI 0.57-2.21, p=0.732).ConclusionNew-onset AF, but not pre-existing AF, is independently associated with elevated mortality in patients hospitalised with Covid-19. This observation highlights the need for careful monitoring of Covid-19 patients with new-onset AF. Further research is needed to explain the mechanistic relationship between new-onset AF and clinical outcomes in Covid-19 patients.

KW - Covid-19

KW - Atrial fibrillation

KW - Covid-19 and cardiovascular complications

KW - Covid-19 and arrhythmia

KW - SARS-CoV-2

U2 - 10.1016/j.hroo.2023.10.004

DO - 10.1016/j.hroo.2023.10.004

M3 - Article

SN - 2666-5018

JO - Heart Rhythm O2

JF - Heart Rhythm O2

ER -

Atrial Fibrillation and In-Hospital Mortality in Covid-19 patients

Abstract / Description of output

Keywords / Materials (for Non-textual outputs)

Access to Document

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Projects

Informing atrial fibrillation rhythm control strategies using electrophysiological testing, cardiac imaging and computational modelling

Cite this