Poor Outcomes in Intensive Care Unit Patients with COVID-19 and Atrial Fibrillation

Citing a lack of data in medium- and long-term outcomes for critically ill patients with COVID-19 infection who develop atrial fibrillation (AF), Michael W. Foster and colleagues retrospectively assessed patients who were admitted to an intensive care unit (ICU) with COVID-19 between March and June 2020. In their article, presented at the American College of Cardiology Annual Scientific Session & Expo (ACC.22), the researchers found that onset of AF in COVID-19 was associated with increased mortality and decreased survival over 18 months.

The investigators noted that the mechanisms of these associations “remain to be elucidated in future studies,” but they proposed that “the association of AF with cardiac injury markers may represent an atriopathy or myo-pericardiopathy in critically ill patients with SARS-CoV2 infection.”

The retrospective cohort included 211 patients, of which 47 had confirmed AF. Patients with AF during hospitalization were compared to patients without for the 18-month period. According to the article, the cohorts were statically similar in age, sex, race, and median body mass index (BMI).

The researchers reported that 28% of patients in the AF group had a prior diagnosis of heart failure (HF), compared to 12% in the non-AF group (p = 0.138). Moreover, the AF group had a higher mean troponin-T level (133.6 vs. 116 ng/L; p = 0.007) and were more likely to have an outpatient prescription for BB (p = 0.031), AAD (p = 0.0001), loop diuretic (p = 0.021), and CCB (p = 0.05). Finally, the investigators observed significantly higher mortality (60 vs.35%; p = 0.007), and significantly lower survival in the AF group over 18 months.