Incidence and prognostic significance of newly-diagnosed atrial fibrillation among older U.S. veterans hospitalized with COVID-19

• Type of Material: Article
• Authors: Darae Ko, Boston University; Tiomthy M. Treu, VA Boston Healthcare System; Laura Tarko, VA Boston Healthcare System; Yuk-Lam Ho, VA Boston Healthcare System; Sarah R. Preis, VA Boston Healthcare System; Ludovic Trinquart, Boston University; David R. Gagnon, Boston University; Kevin M. Monahan, Boston University; Robert H. Helm, Boston University; Ariela R. Orkaby, Harvard Medical School; Steven A. Lubitz, Massachusetts General Hospital; Nicholas A. Bosch, Boston University; Allan J. Walkey, Boston University; Kelly Cho, Harvard Medical School; Peter W.F. Wilson, Emory University; Emelia J. Benjamin, Boston University
• Language: English
• Date: 2024-01-10
• Publisher: Springer Nature
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s) 2024
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): https://doi.org/10.1038/s41598-024-51177-6
• Title of Journal or Parent Work: Scientific Reports
• Volume: 14
• Start Page: 952
• Grant/Funding Agency: VA Information Resource Center; VA Health Services Research and Development Service; Center of Excellence for Suicide Prevention; Department of Veterans Affairs; Veterans Health Administration; National Center for Advancing Translational Sciences; National Heart, Lung, and Blood Institute; American Heart Association
• Grant/Funding Information: Support for VA/CMS data are provided by the Department of Veterans Affairs, VA Health Services Research and Development Service, VA Information Resource Center (Project Numbers SDR 02-237 and 98-004). Veterans Health Administration, Center of Excellence for Suicide Prevention. Joint Department of Veterans Affairs and Department of Defense Mortality Data Repository. Data compiled from the National Death Index. https://www.mirecc.va.gov/suicideprevention/documents/VA_DoD-MDR_Flyer.pdf; Extract < 7/14/2021 >. This study was funded by VA Merit Award I01 CX001025 to Drs. Wilson and Cho, by K23HL151903-01A1 from the National Heart, Lung, and Blood Institute to Dr. Ko, NHLBI R01 HL136660, R01 HL139751, R01 HL151607 to Dr. Walkey, and R01HL092577 and American Heart Association AF AHA_18SFRN34110082 to Dr. Benjamin. Dr. Trinquart receives support from the American Heart Association (18SFRN34150007). Dr. Bosch receives support from National Center for Advancing Translational Sciences (1KL2TR001411). Dr. Lubitz previously received support from NIH grants R01HL139731 and R01HL157635, and American Heart Association 18SFRN34250007 during this project.
• Keywords: Viral infection; Risk factors; Atrial fibrillation
• Subject - Topics: Arrhythmia; Atrial fibrillation

Abstract

Most prior studies on the prognostic significance of newly-diagnosed atrial fibrillation (AF) in COVID-19 did not differentiate newly-diagnosed AF from pre-existing AF. To determine the association between newly-diagnosed AF and in-hospital and 30-day mortality among regular users of Veterans Health Administration using data linked to Medicare. We identified Veterans aged ≥ 65 years who were hospitalized for ≥ 24 h with COVID-19 from 06/01/2020 to 1/31/2022 and had ≥ 2 primary care visits within 24 months prior to the index hospitalization. We performed multivariable logistic regression analyses to estimate adjusted risks, risk differences (RD), and odds ratios (OR) for the association between newly-diagnosed AF and the mortality outcomes adjusting for patient demographics, baseline comorbidities, and presence of acute organ dysfunction on admission. Of 23,299 patients in the study cohort, 5.3% had newly-diagnosed AF, and 29.2% had pre-existing AF. In newly-diagnosed AF adjusted in-hospital and 30-day mortality were 16.5% and 22.7%, respectively. Newly-diagnosed AF was associated with increased mortality compared to pre-existing AF (in-hospital: OR 2.02, 95% confidence interval [CI] 1.72–2.37; RD 7.58%, 95% CI 5.54–9.62) (30-day: OR 1.86; 95% CI 1.60–2.16; RD 9.04%, 95% CI 6.61–11.5) or no AF (in-hospital: OR 2.24, 95% CI 1.93–2.60; RD 8.40%, 95% CI 6.44–10.4) (30-day: 2.07, 95% CI 1.80–2.37; RD 10.2%, 95% CI 7.89–12.6). There was a smaller association between pre-existing AF and the mortality outcomes. Newly-diagnosed AF is an important prognostic marker for patients hospitalized with COVID-19. Whether prevention or treatment of AF improves clinical outcomes in these patients remains unknown.