Table 2.
Characteristics and main findings of studies on COVID-19 and cardiovascular events and AF.
| Study, year | Study design | Study population | Mean/Median age (years) | Follow-up | Main findings |
| Bhatla A et al., 2020 [76] | Retrospective, single center | 700 COVID-19 hospitalized patients | 50 18 | 74-day period | • Incidence of cardiac events in COVID-19 patients is not only the consequence of the infection, but it is mainly dependent on the severity of the disease |
| • In-hospital mortality: 4.3% | |||||
| - AF was associated with in-hospital mortality (OR 6.73; 95% CI 2.52–17.98) | |||||
| • Factors associated with arrhythmias: | |||||
| - Admission to the ICU (OR for AF 4.68; 95% CI 1.66–13.18; OR for NSVT 8.92; 95% CI 1.73–46.06) | |||||
| - Age (OR for AF 1.05; 95% CI 1.02–1.09) | |||||
| - Heart failure (OR for bradyarrhythmias 9.75; 95% CI 1.95–48.65) | |||||
| Sala S et al., 2020 [77] | Prospective, single center | 132 stable COVID-19 hospitalized patients | 65 14 | Single-day snapshot | • Low prevalence of arrhythmias among clinically stable COVID-19 patients |
| • 9% had arrhythmic events (12 patients): 8/12 AF; 4/12 supraventricular tachyarrhythmias | |||||
| • No differences between swab + patients and those with CT scan-proven pneumonia or requiring CPAP for a more severe illness | |||||
| • Factors associated with AF development: older age; at least one pre-existing risk factor | |||||
| Rav-Acha M et al., 2021 [78] | Retrospective, single center | 390 COVID-19 hospitalized patients | 57.5 (43–74.3) | 6 (2–10.25) days of hospitalization | • 7.2% (28 patients) had arrhythmias during hospitalization |
| • The most frequent arrhythmia amongst COVID-19 patients is AF (20/28) | |||||
| • Factors associated with new tachyarrhythmias: | |||||
| - Age (OR 1.04, 95% CI 1.01–1.08) | |||||
| - CHF (OR 4.78, 95% CI 1.31–17.48) | |||||
| - Syncope/Palpitation (OR 7.57, 95% CI 1.27–45.17) | |||||
| - Disease severity (OR 8.91, 95% CI 1.68–47.29 for critical illness) | |||||
| Romiti GF et al., 2021 [79] | Metanalysis of studies reporting AF prevalence in COVID-19 patients | 31 studies | N/A | N/A | • Prevalence of AF in COVID-19 patients: 8.0% of patients had AF |
| • Factors associated with AF: age; male gender; hypertension; DM; CAD; CHF; critical COVID-19 disease | |||||
| 187,716 COVID-19 hospitalized patients | |||||
| • AF is associated with | |||||
| - increased all-cause mortality risk (OR 3.97, 95% CI 2.76–5.71) | |||||
| - in-hospital mortality (OR 3.52, 95% CI 2.44–5.10) | |||||
| - 30-days mortality (OR 7.34, 95% CI 3.11–17.34) | |||||
| Lip GYH et al., 2021 [80] | Prospective observational | 280,592 | 72.5 (SD 9.9) | 8-month study | • COVID-19 status has a stronger association with incident AF than classic cardiovascular risk factors |
| period | |||||
| - with and without incident COVID-19 infection | |||||
| - with cardiovascular and non-cardiovascular multimorbidities | • Incidence of AF in the new COVID-19 cases was 2.5% vs. 0.6% in the non-COVID-19 cases | ||||
| - without AF history | • Factors associated with incident AF: | ||||
| - COVID-19 infection (OR 3.12; 95% CI 2.61–3.710); | |||||
| - congestive HF (OR 1.72; 95% CI 1.50–1.96); | |||||
| - CAD (OR 1.43; 95% CI 1.27–1.60); | |||||
| - VHD (OR 1.42; 95% CI 1.26–1.60) | |||||
| Rivera-Caravaca JM et al., 2021 [81] | Retrospective observational | 1270 outpatient with COVID-19 and cardiometabolic disease | 67.7 12.8 | Up to 30-days after COVID-19 diagnosis | • In COVID-19 outpatients with cardiometabolic diseases, prior use of NOAC therapy vs. VKA therapy was associated with a lower risk of thrombotic outcomes (both arterial and venous), without increasing bleeding risk: |
| - 635 on VKAs | - higher risk of ischemic stroke/TIA/SE at 30-days after COVID-19 diagnosis in VKA users vs. NOAC users (HR 2.42, 95% CI 1.20–4.88); | ||||
| - 635 on NOACs | - similar risk between VKA and NOACs patients for all-cause mortality, ICU admission/MV necessity, ICH/gastrointestinal bleeding | ||||
| Denegri A et al., 2021 [82] | Retrospective, single center | 201 COVID-19 hospitalized patients | 68.5 14.7 | 30-days | • Higher survival in COVID-19 pneumonia patients in sinus rhythm at hospital admission |
| • 20.9% 30-day mortality | |||||
| • ECG at admission predictors of increased mortality: | |||||
| - AF (OR 12.74, 95% CI 3.65–44.48) | |||||
| - ST segment depression (OR 5.30, 95% CI 1.50–18.81) | |||||
| - QTc-interval prolongation (OR 3.17, 95% CI 1.24–8.10) | |||||
| • Independent predictors of increased survival: | |||||
| - sinus rhythm (HR 2.7, 95% CI 1.1–7.0) | |||||
| - LMWH (HR 8.5, 95% CI 2.0–36.6) |
Abbreviations: AF, atrial fibrillation; OR, odds ratio; CAD, coronary artery disease; CHF, congestive heart failure; CI, confidence interval; CPAP, continuous positive airway pressure; CT, computed tomography; DM, diabetes mellitus; NOACs, Non-vitamin K oral anticoagulants; HF, heart failure; HR, hazard ratio; ICH, intracranial haemorrhage; ICU, intensive care unit; LMWH, low molecular weight heparin; MV, mechanical ventilation; OR, odds ratio; QTc, corrected QT interval; SD, standard deviation; SE, systemic embolism; TIA, transient ischemic attack; VHD, valvular heart disease; VKAs, vitamin K antagonists.