ABSTRACT
Background: Coronavirus disease 2019 (COVID-19) is a systemic disease with cardiovascular involvement, including cardiac arrhythmias. Notably, new-onset atrial fibrillation (AF) and atrial flutter (AFL) during hospitalisation in COVID-19 patients have been associated with increased mortality. However, how this risk is impacted by sex and age is still poorly understood. Aim(s): The aim of this study was to explore the relation of AF and AFL to in-hospital mortality, with specific attention for sex-and age-related differences. Method(s): For this multicentre cohort study, we extracted demographics, medical history, occurrence of electrical disorders and in-hospital mortality from the large international patient registry CAPACITY-COVID. For each electrical disorder, prevalence during hospitalisation was calculated. Subsequently, we analysed the incremental prognostic effect of developing AF/AFL on in-hospital mortality, using multivariable logistic regression analyses, stratified for sex and age. Result(s): In total, 5,782 patients (64% male;median age 67) were included. Of all patients 11.0% (95% CI 10.2-11.8) experienced AF and 1.6% (95% CI 1.3-1.9) experienced AFL during hospitalisation. Ventricular arrhythmias were rare (< 0.8% (95% CI 0.6-1.0)) and a conduction disorder was observed in 6.3% (95% CI 5.7-7.0). An event of AF/AFL appeared to occur more often in patients with pre-existing heart failure. After multivariable adjustment for age and sex, new-onset AF/AFL was significantly associated with a poorer prognosis, exemplified by a two-to three-fold increased risk of in-hospital mortality in males aged 60-72 years, whereas this effect was largely attenuated in older male patients and not observed in female patients (Figure 1). Conclusion(s): In this large COVID-19 cohort, new-onset AF/AFL was associated with increased in-hospital mortality, yet this increased risk was restricted to males aged 60-72 years.
ABSTRACT
Background: Cardio-embolic conditions were shown to be predictive of clinical deterioration in hospitalised patients with coronavirus disease 2019 (COVID-19). Whether this also holds for outpatients managed in primary care is yet unknown. Aim(s): The aim of this study was to determine the incremental prognostic value of cardio-embolic vulnerability in predicting the risk of hospital referral in primary care COVID-19 outpatients. Method(s): Data were retrospectively collected from three large Dutch primary care registries. Consecutive adult patients seen in primary care for COVID-19 symptoms in the 'first wave' of COVID-19 infections (March 1 2020 to June 1 2020) and in the 'second wave' (June 1 2020 to April 15 2021) were included. A multivariable logistic regression model was fitted to predict hospital referral within 90 days after first COVID-19 consultation in primary care. Data from the 'first wave' was used for derivation. Age, sex, the interaction between age and sex, and the number of cardiovascular and thrombo-embolic conditions and/or diabetes (0, 1, or >=2) were pre-specified as candidate predictors. This full model was (i) compared to a simple model including only age and sex and its interaction, and (ii) externally validated in COVID-19 patients during the 'second wave'. Result(s): There were 5,475 patients included for model development and 16,693 for external validation. The full model performed better than the simple model (likelihood ratio test p < 0.001). Older male patients with multiple cardio-embolic conditions and/or diabetes had the highest predicted risk of hospital referral, reaching risks above 15-20%, whereas on average this risk was 5.1%. The temporally validated c-statistic was 0.747 (95%CI 0.729-0.764) and the model showed good calibration upon validation. Conclusion(s): For patients with COVID-19 symptoms managed in primary care, the risk of hospital referral was on average 5.1%. Older, male and cardio-embolic vulnerable COVID-19 patients are more at risk for hospital referral.