High-Dose Steroids Not Linked to New-Onset AF in Patients Hospitalized for COVID-19

Nurse checking patient’s health condition in hospital ward. Male nurse visiting the hospital room for routine checkup of senior male patient.
Researchers investigated whether receiving treatment with high-dose corticosteroids was associated with developing atrial fibrillation in patients with COVID-19.

The following article is a part of conference coverage from the American College of Cardiology’s 71st Annual Scientific Session & Expo being held in Washington, DC, from April 2 to 4, 2022. The team at Cardiology Advisor will be reporting on the latest news and research conducted by clinicians and scientists in the field. Check back for more from the ACC 2022 .


Treatment with high-dose corticosteroids in patients hospitalized with COVID-19 does not appear to be a significant contributor to the prevalence of new-onset atrial fibrillation (AF), according to study results presented at the American College of Cardiology 71st Annual Scientific Session & Expo, from April 2nd through 4th, in Washington, DC.

Recognizing that AF is the most common cardiac arrhythmia among patients with COVID-19, the investigators sought to evaluate the arrhythmogenic potential of high-dose corticosteroid treatment among patients hospitalized with SARS-CoV-2 infection who developed new-onset AF.

For the analysis, researchers conducted a multicenter inpatient study using data from 14 hospitals across north Texas from January 1, 2020 to December 31, 2020. Study participants were aged over 18 years and had a positive COVID-19 diagnosis. All patients who had a medical history of AF were excluded from the study. Corticosteroid exposure was defined via analysis of each patient’s pharmacy records. All of the participants in the corticosteroid-exposed arm received a daily dose of greater than 7.5 mg prednisone equivalents (supraphysiologic doses). New-onset AF was identified with the use of ICD billing codes that were generated during the patients’ hospital stay.

Researchers identified 7255 COVID-19-positive hospital admissions. Of these individuals, 3712 patients met the study inclusion criteria. Among the sample of participants, 83.51% (3100 of 3712) of patients were treated with corticosteroids and 16.49% (612 of 3712) of them did not receive corticosteroids.

Overall, 17.10% (530 of 3100) of those in the corticosteroid group developed AF, compared with 18.63% (114 of 612) of those in the noncorticosteroid group. Researchers determined that receiving treatment with high-dose corticosteroids (>7.5 mg daily prednisolone equivalents) was not a statistically significant predictor of new-onset AF (odds ratio, 0.91; 95% CI, 0.69-1.20; P =.50).

“The results of this study are reassuring,” the study authors noted. “[…]Prior studies in non-COVID patients suggested a possible link between corticosteroid exposure and AF; however, this was not observed in this multi-center study.”


McMahan D. The incidence of new-onset atrial fibrillation in hospitalized COVID-19 patients receiving high dose corticosteroids. Presented at: American College of Cardiology (ACC) 71st Annual Scientific Session & Expo; April 2-4, 2022; Washington, DC.

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