More than 5% of patients hospitalized with COVID-19 go on to develop new-onset atrial fibrillation (AFib), according to new research published in Circulation: Arrhythmia and Electrophysiology. The study’s authors fear that this is likely to have a significant impact on the cardiovascular health of an entire generation of Americans.
The analysis included data from nearly 31,000 adult patients hospitalized for COVID-19 at one of 120 facilities throughout the United States from January 2020 to March 2021. More than 27,000 of those patients had no prior history of AFib. All data came from the American Heart Association (AHA) COVID-19 Cardiovascular Disease Registry.
“These findings will influence whether AF-specific therapies should be explored to improve outcomes in patients with COVID-19,” wrote lead author Anna G. Rosenblatt, MD, a cardiologist with the University of Texas Southwestern in Dallas, and colleagues.
Overall, focusing on patients with no prior history of AFib, the researchers found that 5.4% of patients went on to develop new-onset AFib after being hospitalized with a confirmed COVID-19 infection. These patients tended to be older and were more likely to be men. They were also more likely to present with hypertension and/or heart failure than patients who did not develop new-onset AFib.
Another key takeaway was that the in-hospital mortality rate was significantly higher when patients developed new-onset AFib (45.2%) than when they did not (11.9%). This was also true when just looking at patients admitted to the facility’s intensive care unit (ICU).
Rosenblatt et al. emphasized that they explored these findings using multiple models. When not making any adjustments for comorbidities or disease severity, new-onset AFib was linked to a higher risk of mortality. However, when adjusting for these key patient factors, new-onset AFib was no longer strongly associated with a higher mortality risk. The fully adjusted model did point to a link between new-onset AFib and major adverse cardiac events (MACEs), but that connection was not nearly as strong as it was in the unadjusted model.
“Our findings do not support a causal association between incident AFib and mortality among patients hospitalized with COVID-19,” the authors wrote. “However, an attenuated association was found between new-onset AF and MACE in the fully adjusted model. These findings predominantly suggest that AFib is a marker of disease severity, though specific AFib-directed therapies such at rhythm control and anticoagulation need to be further investigated to assess the impact on MACE event occurrences.”
The pandemic’s long-term impact on heart rhythm issues
In a prepared statement highlighting this research, cardiac electrophysiologist Jonathan Piccini, MD, MHS, volunteer chair of the AHA’s Atrial Fibrillation Systems of Care Advisory Group, noted that the pandemic will likely have an impact on AFib rates for the foreseeable future.
“In 2001, experts predicted the number of Americans living with AFib would double by 2050 — the situation may be more dire following the COVID-19 pandemic,” Piccini said. “Research suggests AFib is likely to influence more Americans and could put more people at greater risk of stroke and heart failure than previously expected.”