Permanent atrial fibrillation portends poor outcomes in hospitalized patients with COVID-19: A retrospective observational study.

Background: Data specifically addressed to whether atrial fibrillation (AF) would contribute to increasing the risk for severe forms of novel coronavirus disease (COVID-19) or worse prognosis remain unclear. Hence, we sought to assess the association of permanent AF with in-hospital outcomes in patients with COVID-19.

Methods: This was a single-centered, retrospective, observational study including consecutive hospitalized patients with COVID-19. The primary outcome for the study was defined as all cause in-hospital mortality. Clinical characteristics and outcomes of patients with AF were compared to patients without AF.

Results: Three hundred and fifty hospitalized COVID-19 patients (median age of 55 years, 55.4% men) were enrolled. Of them 40 (11.4%) had AF. Patients with AF were older; were more likely to have co-morbidities, abnormal chest radiography findings and deteriorated laboratory parameters such as D-dimer, troponin, albumin, urea. In-hospital mortality was higher in patients with AF compared to patients without AF (32.5% vs. 13.5%, log-rank p = 0.002, RR 2.40). The number of patients who needed intensive care unit (55% vs. 31%, p = 0.002) and invasive mechanical ventilation (35% vs 15.2%, p = 0.002) were also higher in the AF group. In addition, length of in-hospital stay was longer in patients with AF (median 8 vs. 7 days, p = 0.008). After adjustment for age and co-morbidities, multivariable analyses revealed that AF (HR: 2.426, 95% CI: 1.089-5.405, p = 0.032) was independently associated with in-hospital death.

Conclusions: AF was seen with together markers of severe COVID-19, and the presence of AF was an independent predictor of in-hospital mortality in patients with COVID-19.