ABSTRACT
Background: Atrial fibrillation (AF) has been described as a common cardiovascular manifestation in patients suffering from coronavirus disease 2019 (COVID-19) and is discussed to be a potential risk factor for a poor clinical course. AF is also already known to be associated with increased risk for all cause death. Purpose: In the present study we sought to investigate the impact of AF on the clinical trajectory of patients suffering from COVID-19. Methods:We included all patients hospitalized due to COVID-19 in 2020 in our Hospital. A poor clinical trajectory was defined as transfer to intensive care unit (ICU), intermediate care unit (IMC) or death from any cause. Initial ECGs were analyzed in consensus by two experienced readers. First, we compared patients with poor clinical trajectory vs. good clinical course. Secondly, the study population was categorized into two groups with or without AF on admission. A subgroup analysis was performed to differentiate between new onset AF and patients with known history of AF. To compensate for confounders (age, BMI, known cardiomyopathy (CMP), known coronary artery disease (CAD), chronic airway disease, renal insufficiency, diabetes, arterial hypertension and sex), a full clinically validated multiple logistic regression model with poor clinical trajectory as dependent target variable was performed. Results: From our enrolled 666 patients in 2020 (58% male, average age: 66 (IQR:58-80)) 223 patients (33.5%) experienced a poor clinical course. 179 (27%) patients were transferred to IMC/ICU and 86 (13%) patients died. All in all, patients with poor clinical trajectory were more frequently male (70% vs. 52%;P<0.001), older (71±14 vs. 64±20;P<0.001) and had significantly more co-morbidities such as CAD, CMP, hypertension and diabetes in comparison to patients with a good clinical course. 96 (14.4%) had AF on admission. Among these 37.5% had new-onset AF, which showed similar baseline characteristics as patients without AF. Indeed, patients with COVID-19 and new onset AF were more likely to die (25% vs 12%;P=0.038), or be in need for ICU/IMC (25% vs. 62%;P<0.001) and therefore experienced a poor clinical trajectory more frequently (75% vs. 31%;P<0.001) with a confounder adjusted OR of 5.89. In the subgroup analysis of all patients with AF on admission. Patients with new onset of AF had significantly more underlying CMP, Diabetes and chronic airways disease. While mortality was not higher in patients with new onset of AF, IMC/ICU transfers (62% vs 24%;P<0.001) and as a result poor clinical trajectory (75% vs 40%;P=0.001) was significantly increased in comparison to patients with known AF. Conclusion: In patients suffering from COVID-19, new onset of AF on admission was associated with a poor clinical course and higher in-hospital mortality.
ABSTRACT
Introduction: There is insufficient evidence regarding the role of respirators in the prevention of SARS-CoV-2 infection. Objectives: We analysed the impact of filtering facepiece class 2 (FFP2) vs. surgical masks on the risk of SARS-CoV-2 acquisition in Swiss healthcare workers (HCW). Methods: Our prospective multicentre cohort enrolled HCW from June to August 2020, who were asked about COVID-19 risk exposures/behaviours, including preferred mask type when caring for COVID-19 patients outside of aerosol-generating procedures (AGP). HCW performing AGP were also asked about universal FFP2 use (i.e. irrespective of patients' COVID-19 status). We assessed the impact of FFP2 on i) self-reported SARS-CoV- 2-positive nasopharyngeal PCR/rapid antigen tests (weekly surveys), and ii) SARS-CoV-2 seroconversion (baseline to January/February 2021). Results: We enrolled 3'259 participants from nine healthcare institutions, whereof 716 (22%) preferentially used FFP2 respirators. Among these, 81/716 (11%) reported a SARS-CoV-2-positive swab, compared to 352/2543 (14%) surgical mask users (median follow-up 242 days);seroconversion was documented in 85/656 (13%) FFP2 and 426/2255 (19%) surgical mask users. Adjusted for baseline characteristics, COVID-19 exposure, and risk behaviour, FFP2 use was marginally associated with a decreased risk for SARS-CoV-2-positive swab (aHR 0.8, p = 0.052) and seroconversion (aOR 0.7, p = 0.053);household exposure was the strongest risk factor (aHR for positive swab 10.1, p < 0.001;aOR for seroconversion 5.0, p < 0.001). In subgroup analysis, FFP2 use was clearly protective among HCW with frequent (> 20 patients) COVID-19 exposure (aHR 0.7, p < 0.001;aOR 0.6, p = 0.036). Universal FFP2 use during AGP showed no additional protective effect (aHR 1.1, p = 0.7;aOR 0.9, p = 0.53). Conclusion: FFP2 compared to surgical masks may convey additional protection from SARS-CoV-2 for HCW with frequent exposure to COVID-19 patients. (Figure Presented).