Atrial fibrillation status and associations with adverse clinical outcomes in patients hospitalised with COVID-19: a large unselected statewide population-linkage study

Jia Yi Anna Ne; Clara K Chow; Vincent Chow; Karice Hyun; Leonard Kritharides; David Brieger; Austin Chin Chwan Ng

doi:10.1093/ehjqcco/qcae115

Atrial fibrillation status and associations with adverse clinical outcomes in patients hospitalised with COVID-19: a large unselected statewide population-linkage study

Eur Heart J Qual Care Clin Outcomes. 2025 Jan 2:qcae115. doi: 10.1093/ehjqcco/qcae115. Online ahead of print.

Authors

Jia Yi Anna Ne^{1

2

3}, Clara K Chow^{2

3}, Vincent Chow^{1

3}, Karice Hyun¹, Leonard Kritharides^{1

3}, David Brieger^{1

3}, Austin Chin Chwan Ng^{1

3}

Affiliations

¹ Concord Repatriation General Hospital, Department of Cardiology, Concord, NSW, Australia.
² Westmead Hospital, Department of Cardiology, Westmead, NSW, Australia and Westmead Applied Research Centre, The University of Sydney, NSW, Australia.
³ The University of Sydney, NSW, Australia.

PMID: 39749838
DOI: 10.1093/ehjqcco/qcae115

Abstract

Background: Atrial fibrillation (AF) is common in COVID-19 patients. The impact of AF on major-adverse-cardiovascular-events (MACE defined as all-cause mortality, myocardial infarction, ischemic stroke, cardiac failure or coronary revascularisation), recurrent AF admission and venous thromboembolism in hospitalised COVID-19 patients is unclear.

Methods: Patients admitted with COVID-19 (1-January-2020 to 30-September-2021) were identified from the New South Wales Admitted-Patient-Data-Collection database, stratified by AF status (no-AF vs prior-AF or new-AF during index COVID-19 admission) and followed-up until 31-Mar-2022. Multivariable Cox regression and competing risk analyses were performed to assess the impact of AF on MACE and non-fatal outcomes respectively.

Results: Our cohort comprised 145293 COVID-19 patients (median age 67.4yo; 49.7% males): new-AF, n=5140 (3.5%); prior-AF, n=23204 (16.0%). During a median follow-up of 9-months, prior-AF and new-AF patients had significantly higher MACE events (44.7% vs 36.2% vs 18.0%) and all-cause mortality (36.0% vs 28.7% vs 15.2%) compared to no-AF patients (both logrank P<0.001). After adjusting for age, gender, intensive-care-unit admission, referral source and comorbidities, compared to no-AF, new-AF and prior-AF groups were independently associated with MACE (adjusted hazard ratio[aHR]=1.15, 95% confidence interval[CI]=1.09-1.20; aHR=1.36, 95%CI=1.33-1.40 respectively). Competing risk analyses showed rehospitalisation rates for ischemic stroke, cardiac failure and AF, but not venous thromboembolism, were significantly higher in these patients. Both new-AF and prior-AF patients had higher rehospitalisation rates for ischemic stroke compared to no-AF patients, independent of CHA2DS2VASc.

Conclusions: COVID-19 patients with AF are at high risk of adverse clinical outcomes. Such patients may need increased surveillance and consideration for early anticoagulation.

Keywords: Atrial fibrillation; COVID-19; MACE; adverse clinical outcomes; all-cause mortality.