open access

Vol 29, No 1 (2022)
Original Article
Submitted: 2021-11-09
Accepted: 2021-11-27
Published online: 2021-12-09
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Outcomes and mortality associated with atrial arrhythmias among patients hospitalized with COVID-19: A systematic review and meta-analysis

Lukasz Szarpak123, Krzysztof J. Filipiak4, Aleksandra Skwarek5, Michal Pruc3, Mansur Rahnama6, Andrea Denegri7, Marta Jachowicz8, Malgorzata Dawidowska1, Aleksandra Gasecka4, Milosz J. Jaguszewski9, Lukasz Iskrzycki10, Zubaid Rafique11
·
Pubmed: 34897631
·
Cardiol J 2022;29(1):33-43.
Affiliations
  1. Institute of Outcomes Research, Maria Sklodowska-Curie Medical Academy, Warsaw, Poland
  2. Research Unit, Maria Sklodowska-Curie Bialystok Oncology Center, Bialystok, Poland
  3. Research Unit, Polish Society of Disaster Medicine, Warsaw, Poland
  4. Institute of Clinical Medicine, Maria Sklodowska-Curie Medical Academy, Warsaw, Poland
  5. 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
  6. Chair and Department of Oral Surgery, Medical University of Lublin, Poland
  7. Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
  8. Students Research Club, Maria Sklodowska-Curie Medical Academy, Warsaw, Poland, Poland
  9. 1st Department of Cardiology, Medical University of Gdansk, Poland
  10. Department of Emergency Medical Service, Medical University of Wroclaw, Poland
  11. Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, United States

open access

Vol 29, No 1 (2022)
Original articles — COVID-19
Submitted: 2021-11-09
Accepted: 2021-11-27
Published online: 2021-12-09

Abstract

Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia in the adult population. Herein, is a systematic review with meta-analysis to determine the impact of AF/atrial flutter (AFL) on mortality, as well as individual complications in patients hospitalized with the coronavirus disease 2019 (COVID-19).
Methods: A systematic search of the SCOPUS, Medline, Web of Science, CINAHL and Cochrane databases was performed. The a priori primary outcome of interest was in-hospital mortality. A random-effects model was used to pool study results.
Results: Nineteen studies which included 33,296 patients were involved in this meta-analysis. Inhospital mortality for AF/AFL vs. no-AF/AFL groups varied and amounted to 32.8% vs. 14.2%, respectively (risk ratio [RR]: 2.18; 95% confidence interval [CI]: 1.79–2.65; p < 0.001). In-hospital mortality in new onset AF/AFL compared to no-AFAFL was 22.0% vs. 18.8% (RR: 1.86; 95% CI: 1.54–2.24; p < 0.001). Intensive care unit (ICU) admission was required for 17.7% of patients with AF/AFL compared to 10.8% for patients without AF/AFL (RR: 1.94; 95% CI: 1.04–3.62; p = 0.04).
Conclusions: The present study reveals that AF/AFL is associated with increased in-hospital mortality and worse outcomes in patients with COVID-19 and may be used as a negative prognostic factor in these patients. Patients with AF/AFL are at higher risk of hospitalization in ICU. The presence of AF/AFL in individuals with COVID-19 is associated with higher risk of complications, such as bleeding, acute kidney injury and heart failure. AF/AFL may be associated with unfavorable outcomes due to the hemodynamic compromise of cardiac function itself or hyperinflammatory state typical of these conditions.

Abstract

Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia in the adult population. Herein, is a systematic review with meta-analysis to determine the impact of AF/atrial flutter (AFL) on mortality, as well as individual complications in patients hospitalized with the coronavirus disease 2019 (COVID-19).
Methods: A systematic search of the SCOPUS, Medline, Web of Science, CINAHL and Cochrane databases was performed. The a priori primary outcome of interest was in-hospital mortality. A random-effects model was used to pool study results.
Results: Nineteen studies which included 33,296 patients were involved in this meta-analysis. Inhospital mortality for AF/AFL vs. no-AF/AFL groups varied and amounted to 32.8% vs. 14.2%, respectively (risk ratio [RR]: 2.18; 95% confidence interval [CI]: 1.79–2.65; p < 0.001). In-hospital mortality in new onset AF/AFL compared to no-AFAFL was 22.0% vs. 18.8% (RR: 1.86; 95% CI: 1.54–2.24; p < 0.001). Intensive care unit (ICU) admission was required for 17.7% of patients with AF/AFL compared to 10.8% for patients without AF/AFL (RR: 1.94; 95% CI: 1.04–3.62; p = 0.04).
Conclusions: The present study reveals that AF/AFL is associated with increased in-hospital mortality and worse outcomes in patients with COVID-19 and may be used as a negative prognostic factor in these patients. Patients with AF/AFL are at higher risk of hospitalization in ICU. The presence of AF/AFL in individuals with COVID-19 is associated with higher risk of complications, such as bleeding, acute kidney injury and heart failure. AF/AFL may be associated with unfavorable outcomes due to the hemodynamic compromise of cardiac function itself or hyperinflammatory state typical of these conditions.

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Keywords

atrial fibrillation, atrial flutter, new onset atrial fibrillation, COVID-19, outcome, systematic review, meta-analysis

Supp./Additional Files (2)
Supplementary Table S1. Polled analysis of patient comorbidities among included trials
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About this article
Title

Outcomes and mortality associated with atrial arrhythmias among patients hospitalized with COVID-19: A systematic review and meta-analysis

Journal

Cardiology Journal

Issue

Vol 29, No 1 (2022)

Article type

Original Article

Pages

33-43

Published online

2021-12-09

Page views

6303

Article views/downloads

1418

DOI

10.5603/CJ.a2021.0167

Pubmed

34897631

Bibliographic record

Cardiol J 2022;29(1):33-43.

Keywords

atrial fibrillation
atrial flutter
new onset atrial fibrillation
COVID-19
outcome
systematic review
meta-analysis

Authors

Lukasz Szarpak
Krzysztof J. Filipiak
Aleksandra Skwarek
Michal Pruc
Mansur Rahnama
Andrea Denegri
Marta Jachowicz
Malgorzata Dawidowska
Aleksandra Gasecka
Milosz J. Jaguszewski
Lukasz Iskrzycki
Zubaid Rafique

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