Prevalence and clinical implications of atrial fibrillation in patients hospitalized due to COVID-19: Data from a registry in Poland

Michał Terlecki; Wiktoria Wojciechowska; Marek Klocek; Tomasz Drożdż; Maryla Kocowska-Trytko; Paweł Lis; Christopher Pavlinec; Jan W Pęksa; Michał Kania; Zbigniew Siudak; Andrzej Januszewicz; Reinhold Kreutz; Maciej Małecki; Tomasz Grodzicki; Marek Rajzer; CraCov HHS Investigators

doi:10.3389/fcvm.2023.1133373

Prevalence and clinical implications of atrial fibrillation in patients hospitalized due to COVID-19: Data from a registry in Poland

Front Cardiovasc Med. 2023 Mar 13:10:1133373. doi: 10.3389/fcvm.2023.1133373. eCollection 2023.

Authors

Affiliations

¹ 1st Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Kraków, Poland.
² Department of Metabolic Diseases and Diabetology, Jagiellonian University Medical College, Kraków, Poland.
³ Faculty of Medicine and Health Sciences, Jan Kochanowski University, Kielce, Poland.
⁴ Department of Hypertension, National Institute of Cardiology, Warsaw, Poland.
⁵ Charite-Universitatsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institut für Klinische Pharmakologie und Toxikologie, Berlin, Germany.
⁶ Department of Internal Diseases and Geriatrics, Jagiellonian University Medical College, Kraków, Poland.

Abstract

Background: Atrial fibrillation (AF) is a common arrhythmia with increasing prevalence with respect to age and comorbidities. AF may influence the prognosis in patients hospitalized with Coronavirus disease 2019 (COVID-19). We aimed to assess the prevalence of AF among patients hospitalized due to COVID-19 and the association of AF and in-hospital anticoagulation treatment with prognosis.

Methods and results: We assessed the prevalence of AF among patients hospitalized due to COVID-19 and the association of AF and in-hospital anticoagulation treatment with prognosis. Data of all COVID-19 patients hospitalized in the University Hospital in Krakow, Poland, between March 2020 and April 2021, were analyzed. The following outcomes: short-term (30-days since hospital admission) and long-term (180-days after hospital discharge) mortality, major cardiovascular events (MACEs), pulmonary embolism, and need for red blood cells (RBCs) transfusion, as a surrogate for major bleeding events during hospital stay were assessed. Out of 4,998 hospitalized patients, 609 had AF (535 pre-existing and 74 de novo). Compared to those without AF, patients with AF were older and had more cardiovascular disorders. In adjusted analysis, AF was independently associated with an increased risk of short-term {p = 0.019, Hazard Ratio [(HR)] 1.236; 95% CI: 1.035-1.476} and long-term mortality (Log-rank p < 0.001) as compared to patients without AF. The use of novel oral anticoagulants (NOAC) in AF patients was associated with reduced short-term mortality (HR 0.14; 95% CI: 0.06-0.33, p < 0.001). Moreover, in AF patients, NOAC use was associated with a lower probability of MACEs (Odds Ratio 0.3; 95% CI: 0.10-0.89, p = 0.030) without increase of RBCs transfusion.

Conclusions: AF increases short- and long-term risk of death in patients hospitalized due to COVID-19. However, the use of NOACs in this group may profoundly improve prognosis.

Keywords: COVID-19; MACE; NOAC drugs; anticoagulation; atrial fibrillation; prognosis.

Grants and funding

This publication was supported by the National Center for Research and Development CRACoV-HHS project (Model of multi-specialist hospital and non-hospital care for patients with SARSCoV-2 infection) through the initiative “Support for specialist hospitals in fighting the spread of SARSCoV-2 infection and in treating COVID-19” (contract number SZPITALE-JEDNOIMIENNE/18/2020). The described research was implemented by consortium of the University Hospital in Cracow and the Jagiellonian University Medical College.