Corticosteroids Increase Atrial Fibrillation Risk in Patients With COVID-19

The following article is a part of conference coverage from the American Heart Association Scientific Sessions 2021, being held virtually from November 13 to 15, 2021. The team at Cardiology Advisor will be reporting on the latest news and research conducted by leading experts in cardiology. Check back for more from the AHA Scientific Sessions 2021.

Corticosteroids are associated with an increased risk for atrial fibrillation (AF) in patients hospitalized for COVID-19, according to study results presented at the American Heart Association (AHA) Scientific Sessions 2021, held from November 13 to 15, 2021.

Previous studies have suggested an increased incidence of AF among patients receiving corticosteroids, while other studies have indicated a preventive effect.

Researchers sought to examine the association of steroids and new-onset AF in patients hospitalized for COVID-19. Using a retrospective, multicenter cohort study, researchers examined adult patients being treated for COVID-19 infection at 5 community hospitals and 1 tertiary care clinic between March 1, 2020 and March 31, 2021. Participants were stratified based on exposure to steroids during hospitalization. Group 1 (the full-dose group) received a cumulative dosage, including dexamethasone greater than or equal to 6 mg/day, methylprednisolone greater than or equal to 80 mg/day or hydrocortisone greater than or equal to 50 mg/day for 3 days or more. Group 2 received low-dose steroids, and group 3 was given no steroids. The study excluded patients who stayed fewer than 3 days or who had a history of AF.

Among 4578 total participants (mean age 65.4±61 years, 50.4% women), 542 developed new-onset AF. Of the 1556 participants in group 1, 1046 participants in group 2, and 2156 participants in group 3, 523 (24.3%), 97 (9.3%), and 125 (8%) died during hospitalization, respectively. After adjusting for hypoxia and significant baseline demographics, a multivariable logistic regression showed a higher incidence of AF in group 1 compared with group 3 (adjusted relative risk [aRR], 1.59; 95% CI, 1.27-1.99; P <.001) and group 2 (aRR, 1.39; 95% CI, 1.09-1.77; P =.007). The comparison between group 2 and group 3 did not reach statistical significance (aRR, 1.14; 95% CI, 0.87-1.50; P =.347).

“Corticosteroids, the mainstay of treatment of hypoxic COVID-19 patients, are associated with an increased risk of developing AF. This suggests that steroids have a potential direct arrhythmogenic effect in COVID-19,” the study authors said.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Lee Y, Patel K, Wang D, et al. Corticosteroids and the risk of atrial fibrillation in hospitalized COVID-19 patients. Presented at: AHA Scientific Sessions 2021; November 13-15, 2021. Poster P678.