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

IF 4.8 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

European Heart Journal - Quality of Care and Clinical Outcomes Pub Date : 2025-01-02 DOI:10.1093/ehjqcco/qcae115

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

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引用次数: 0

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.

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2019冠状病毒病住院患者心房颤动状态及其与不良临床结局的关联：一项大型未选择的全州人口关联研究

背景：房颤（AF）在COVID-19患者中很常见。房颤对住院COVID-19患者的主要不良心血管事件（MACE定义为全因死亡率、心肌梗死、缺血性卒中、心力衰竭或冠状动脉血运重建术）、房颤复发入院和静脉血栓栓塞的影响尚不清楚。方法：从新南威尔士州入院患者数据收集数据库中确定2019冠状病毒病（2020年1月1日至2021年9月30日）入院的患者，按房颤状态（入院时无房颤、既往房颤或新发房颤）分层，随访至2022年3月31日。采用多变量Cox回归和竞争风险分析分别评估心房纤颤对MACE和非致命结局的影响。结果：我们的队列包括145293例COVID-19患者(中位年龄67.4岁；49.7%男性)：新房颤，n=5140 (3.5%)；prior-AF, n=23204（16.0%）。在中位9个月的随访期间，与无房颤患者相比，房颤患者和新发房颤患者的MACE事件（44.7% vs 36.2% vs 18.0%）和全因死亡率（36.0% vs 28.7% vs 15.2%）均显著高于无房颤患者（两者均为logrank p）。结论：新冠肺炎合并房颤患者具有较高的不良临床结局风险。这类患者可能需要加强监测并考虑早期抗凝。

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来源期刊

European Heart Journal - Quality of Care and Clinical Outcomes CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

9.40

自引率

3.80%

发文量

期刊介绍： European Heart Journal - Quality of Care & Clinical Outcomes is an English language, peer-reviewed journal dedicated to publishing cardiovascular outcomes research. It serves as an official journal of the European Society of Cardiology and maintains a close alliance with the European Heart Health Institute. The journal disseminates original research and topical reviews contributed by health scientists globally, with a focus on the quality of care and its impact on cardiovascular outcomes at the hospital, national, and international levels. It provides a platform for presenting the most outstanding cardiovascular outcomes research to influence cardiovascular public health policy on a global scale. Additionally, the journal aims to motivate young investigators and foster the growth of the outcomes research community.