Atrial Fibrillation is an Independent Predictor for In-hospital Mortality in Patients Admitted with SARS-CoV-2 Infection

Mountantonakis, Stavros E.; Saleh, Moussa; Fishbein, Joanna; Gandomi, Amir; Lesser, Martin; Chelico, John; Gabriels, James; Qiu, Michael; Epstein, Laurence M.

BACKGROUND: Atrial fibrillation (AF) is the most encountered arrhythmia and has been associated with worse in-hospital outcomes. OBJECTIVE: To determine the incidence of AF among patients hospitalized with COVID-19 as well as its impact on in-hospital mortality. METHODS: Patients hospitalized with a positive COVID-19 polymerase chain reaction test between March 1st and April 27(th), 2020, were identified from the common medical record system of 13 Northwell Health hospitals. Natural language processing search algorithms were utilized to identify and classify AF. Patients were classified as having AF or not. AF was further classified as new-onset vs past history of AF. RESULTS: AF occurred in 1,687 of 9,564 patients (17.6%). Of those, 1,109 patients (65.7%) had new-onset AF. Propensity score matching (PSM) 1,238 pairs of patients with AF and without AF showed higher in-hospital mortality in the AF group (54.3% vs 37.2%, p < 0.0001). Within the AF group, PSM of 500 pairs showed higher in-hospital mortality in patients with new onset AF as compared to a past history of AF (55.2% vs 46.8%, p=0.009). The risk ratio of in-hospital mortality for new onset AF over sinus rhythm patients was 1.56 (95% CI: 1.42 to 1.71, p<0.0001). The presence of cardiac disease was not associated with a higher risk of in-hospital mortality among patients with AF (p=0.1). CONCLUSIONS: Among patients hospitalized with COVID-19, 17.6% experienced AF. AF, particularly new-onset, was an independent predictor of in-hospital mortality.