Implications of atrial fibrillation on the clinical course and outcomes of hospitalized COVID-19 patients: results of the Cardio-COVID-Italy multicentre study

Europace - Tập 23 Số 10 - Trang 1603-1611 - 2021
Sara París1,2, Riccardo M. Inciardi1,2, Carlo Lombardi1,2, Daniela Tomasoni1,2, Pietro Ameri3, Valentina Carubelli1,2, Piergiuseppe Agostoni4, Claudia Canale3, Stefano Carugo5, Gianni Tognoni6, Mattia Di Pasquale1,2, Filippo M. Sarullo7, Maria Teresa La Rovere8, Andrea Mortara9, Massimo Piepoli10,11, Italo Porto3, Gianfranco Sinagra12, Maurizio Volterrani13, Massimiliano Gnecchi14, Sergio Leonardi14, Marco Merlo12, Alfonso Iorio15, Stefano Giovinazzo3, Antonio Bellasi16, G Zaccone1,2, Rita Camporotondo14, Francesco Catagnano9,14, Laura Adelaide Dalla Vecchia17, Gloria Maccagni6, Massimo Mapelli4, Davide Margonato9,17, Luca Monzo18, Vincenzo Nuzzi1,2, Andrea Pozzi15, Giovanni Provenzale5, Claudia Specchia1,2, Chiara Tedino1,2, Marco Guazzi19, Michele Senni15, Marco Metra1,2
1Cardiology
2Cardiology; ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Piazzale Spedali Civili, 125123 Brescia, Italy
3Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino—IRCCS Italian Cardiovascular Network, University of Genova, Genova, Italy
4Division of Cardiology, Department of Clinical Sciences and Community Health, Centro Cardiologico Monzino, University of Milan, Milan, Italy
5Division of Cardiology, Ospedale San Paolo, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
6Division of Cardiology, Ospedale Maggiore di Cremona, Cremona, Italy
7Cardiovascular Rehabilitation Unit, Buccheri La Ferla Fatebenefratelli Hospital, Palermo, Italy
8Istituti Clinici Scientifici Maugeri, IRCCS, Dipartimento di Cardiologia, Istituto Scientifico di Pavia, Pavia, Italy
9Cardiology Department, Policlinico di Monza, Monza, Italy
10Heart Failure Unit, G. da Saliceto Hospital, AUSL Piacenza, Piacenza, Italy
11Institute of Life Sciences, Sant’Anna School of Advanced Studies, Pisa, Italy
12Department of Cardiology, Cardiovascular Department, Azienda Sanitaria Universitaria Integrata, Trieste, Italy
13Department of Medical Sciences, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Pisana Rome, Rome, Italy
14Division of Cardiology, Dipartimento Scienze mediche e malattie infettive, Fondazione IRCCS Policlinico S. Matteo, University of Pavia, Pavia, Italy
15Cardiovascular Department, Cardiology Unit, Papa Giovanni XXIII Hospital-Bergamo, Piazza OMS, 1, 24127 Bergamo, Italy
16Innovation and Brand Reputation Unit, Papa Giovanni XXIII Hospital, Bergamo Research, Bergamo, Italy
17Istituti Clinici Scientifici Maugeri, IRCCS, Dipartimento di Cardiologia, Istituto Scientifico di Milan, Milan, Italy
18Department of Cardiology, Istituto Clinico Casal Palocco, Policlinico Casilino, Rome, Italy
19Heart Failure Unit, Cardiology Department, University of Milan, IRCCS San Donato Hospital, Milan, Italy

Tóm tắt

Abstract Aims To assess the clinical relevance of a history of atrial fibrillation (AF) in hospitalized patients with coronavirus disease 2019 (COVID-19). Methods and results We enrolled 696 consecutive patients (mean age 67.4 ± 13.2 years, 69.7% males) admitted for COVID-19 in 13 Italian cardiology centres between 1 March and 9 April 2020. One hundred and six patients (15%) had a history of AF and the median hospitalization length was 14 days (interquartile range 9–24). Patients with a history of AF were older and with a higher burden of cardiovascular risk factors. Compared to patients without AF, they showed a higher rate of in-hospital death (38.7% vs. 20.8%; P < 0.001). History of AF was associated with an increased risk of death after adjustment for clinical confounders related to COVID-19 severity and cardiovascular comorbidities, including history of heart failure (HF) and increased plasma troponin [adjusted hazard ratio (HR): 1.73; 95% confidence interval (CI) 1.06–2.84; P = 0.029]. Patients with a history of AF also had more in-hospital clinical events including new-onset AF (36.8% vs. 7.9%; P < 0.001), acute HF (25.3% vs. 6.3%; P < 0.001), and multiorgan failure (13.9% vs. 5.8%; P = 0.010). The association between AF and worse outcome was not modified by previous or concomitant use of anticoagulants or steroid therapy (P for interaction >0.05 for both) and was not related to stroke or bleeding events. Conclusion Among hospitalized patients with COVID-19, a history of AF contributes to worse clinical course with a higher mortality and in-hospital events including new-onset AF, acute HF, and multiorgan failure. The mortality risk remains significant after adjustment for variables associated with COVID-19 severity and comorbidities.

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Europace

Tập 23 Số 10

1603-1611

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