Higher incidence of heart failure and arrhythmias in atrial fibrillation patients hospitalized with covid-19

ABSTRACT

Introduction: Atrial fibrillation (Afib) is a common arrhythmia with significant morbidity and mortality. The cardiovascular effect of COVID-19 infection in patients with known Afib is poorly understood. The aim of this study was to analyze the cardiovascular outcomes of patients with a history of Afib who were admitted with COVID-19 infection. Methods: A retrospective cohort study of patients hospitalized between January 1 and July 31, 2020 with COVID-19 infection confirmed by polymerase chain reaction (PCR) testing of nasopharynx sample was stratified by history of Afib, and analyzed for patient characteristics and cardiovascular outcomes using Mann-Whitney & χ tests. A p value of <0.05 was used for statistical significance. Results: Among the 321 patients admitted with a positive COVID-19 test, 12% (38) had a history of Afib. This subgroup was significantly older, median age 84.5 vs. 61 and were predominantly male, 66 vs. 34%. They showed a higher prevalence of heart failure with reduced ejection fraction (HFrEF) (26 vs. 6%) and with preserved ejection fraction (HFpEF) (34 vs. 13%), CAD (34 vs. 17%), chronic kidney disease (45 vs. 20%), and dyslipidemia (66 vs. 35%) compared to those admitted without a history of Afib. These patients had a wider QRS interval 101 (88-134) vs. 94 (86-104) and more elevated BNP levels 278 (109-696.5) vs. 234 (35-158). They were also more likely to experience Afib (53 vs. 7%) and ventricular arrhythmias (18 vs. 6%) during hospitalization, but they did not show any statistical difference in terms of mortality rate, ICU admission, use of mechanical ventilation, or 30-day hospital readmission. Conclusion: Patients admitted with COVID-19 with a history of Afib were older and had comorbid cardiovascular disease. Heart failure risk markers such as wider QRS interval and higher BNP levels were more common in the history of Afib subgroup of patients. These patients had a higher incidence of heart failure and arrhythmias but not mortality.