Among patients hospitalized with COVID-19, new-onset atrial arrhythmias are associated with poor clinical outcomes, according to study findings published in The American Journal of Cardiology.
Atrial arrhythmias (AAs) may indicate a poor chance of recovery in patients hospitalized with COVID-19, and AAs occur at high frequency in this population. Researchers sought to investigate mortality in patients hospitalized with COVID-19 who have new-onset AA or history of AA.
To accomplish this, they conducted a retrospective cohort study of patients in 5 community hospitals and 1 quaternary care center at Henry Ford Health and Trinity Health systems in Michigan, USA, from 2014 to 2021. The study population included 14,174 patients with influenza, and 6927 patients with COVID-19, among whom were 779 patients with history of AA and 626 patients with new-onset AA. The primary endpoint was in-hospital mortality. Secondary outcomes included, but were not limited to, new-onset congestive heart failure (CHF), hospital length of stay and readmission, necessity of intensive care, and thromboembolism.
Among patients hospitalized with COVID-19, AA occurrence (history or new-onset) was 20.3% and, among those hospitalized with influenza AA, occurrence was 13.1%. In-hospital deaths were independently predicted by history of AA (adjusted relative risk [aRR], 1.38; confidence interval [CI], 1.11-1.71; P =.003) and new-onset AA (aRR, 2.02; 95% CI, 1.68-2.43; P <.001). New-onset CHF occurred in 6.3% of patients with history of AA (odds ratio [OR], 1.91; 95% CI, 1.30-2.79; P <.001) and in 11.3% of patients with new-onset AA (OR, 4.01; 95% CI, 3.00-5.35; P <.001). New-onset AA was shown to increase risk for worse clinical outcomes within the propensity-matched COVID-19 and influenza cohorts. Patients with COVID-19 showed a greater risk for new-onset AA than patients with influenza (aRR, 2.02; 95% CI, 1.76-2.32; P <.0001), but associated mortality was more likely among patients with influenza than in patients with COVID-19 (aRR, 12.58; 95% CI, 4.27-37.06; P <.0001) and (aRR, 1.86; 95% CI, 1.55-2.22; P <.0001) respectively.
Study limitations included the observational study design and possible unexamined confounder bias. Researchers also noted that they did not examine the relationship in time between AA onset and in-hospital outcomes, follow-up beyond hospital discharge, or examine the cause of death.
“The incidence of new-onset CHF was higher in patients with new-onset AA than patients with [normal sinus rhythm] in both cohorts,” the study authors wrote. “Previous or new-onset atrial AA did not increase the prevalence of echocardiographic abnormalities in patients with COVID-19.”
Jehangir Q, Lee Y, Latack K, et al. Incidence, mortality, and imaging outcomes of atrial arrhythmias in COVID-19. Am J Cardiol. Published online April 2, 2022. doi:10.1016/j.amjcard.2022.02.051