tetano
Editor, Senior Moderator
Rev Esp Cardiol (Engl Ed)
. 2021 Jan 13;S1885-5857(21)00001-3.
doi: 10.1016/j.rec.2020.12.009. Online ahead of print.
Atrial fibrillation in patients with COVID-19. Usefulness of the CHA [SUB]2[/SUB] DS [SUB]2[/SUB]-VASc score: an analysis of the international HOPE COVID-19 registry
[Article in English, Spanish]
Aitor Uribarri[SUP] 1 [/SUP], Iv?n J N??ez-Gil[SUP] 2 [/SUP], ?lvaro Aparisi[SUP] 3 [/SUP], Ram?n Arroyo-Espliguero[SUP] 4 [/SUP], Charbel Maroun Eid[SUP] 5 [/SUP], Rodolfo Romero[SUP] 6 [/SUP], V?ctor M Becerra-Mu?oz[SUP] 7 [/SUP], Gisela Feltes[SUP] 8 [/SUP], Mar?a Molina[SUP] 9 [/SUP], Marcos Garc?a-Aguado[SUP] 10 [/SUP], Enrico Cerrato[SUP] 11 [/SUP], Thamar Capel-Astrua[SUP] 12 [/SUP], Emilio Alfonso-Rodr?guez[SUP] 13 [/SUP], Alex F Castro-Mej?a[SUP] 14 [/SUP], Sergio Raposeiras-Roub?n[SUP] 15 [/SUP], Carolina Espejo[SUP] 16 [/SUP], Nerea P?rez-Sol?[SUP] 17 [/SUP], Alfredo Barjard?[SUP] 18 [/SUP], Francisco Mar?n[SUP] 19 [/SUP], ?scar Fabregat-Andr?s[SUP] 20 [/SUP], Fabrizio D'ascenzo[SUP] 21 [/SUP], Francesco Santoro[SUP] 22 [/SUP], Ibrahim Akin[SUP] 23 [/SUP], Vicente Estrada[SUP] 2 [/SUP], Antonio Fern?ndez-Ortiz[SUP] 2 [/SUP], Carlos Macaya[SUP] 2 [/SUP], HOPE COVID-19 investigators
Affiliations
Abstract
Introduction and objectives: Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2. Atrial fibrillation (AF) is common in acute situations, where it is associated with more complications and higher mortality.
Methods: Analysis of the international HOPE registry (NCT04334291). The objective was to assess the prognostic information of AF in COVID-19 patients. A multivariate analysis and propensity score matching were performed to assess the relationship between AF and mortality. We also evaluated the impact on mortality and embolic events of the CHA[SUB]2[/SUB]DS[SUB]2[/SUB]-VASc score in these patients.
Results: Among 6217 patients enrolled in the HOPE registry, 250 had AF (4.5%). AF patients had a higher prevalence of cardiovascular risk factors and comorbidities. After propensity score matching, these differences were attenuated. Despite this, patients with AF had a higher incidence of in-hospital complications such as heart failure (19.3% vs 11.6%, P=.021) and respiratory insufficiency (75.9% vs 62.3%, P=.002), as well as a higher 60-day mortality rate (43.4% vs 30.9%, P=.005). On multivariate analysis, AF was independently associated with higher 60-day mortality (hazard ratio, 1.234; 95%CI, 1.003-1.519). CHA[SUB]2[/SUB]DS[SUB]2[/SUB]-VASc score acceptably predicts 60-day mortality in COVID-19 patients (area ROC, 0.748; 95%CI, 0.733-0.764), but not its embolic risk (area ROC, 0.411; 95%CI, 0.147-0.675).
Conclusions: AF in COVID-19 patients is associated with a higher number of complications and 60-day mortality. The CHA[SUB]2[/SUB]DS[SUB]2[/SUB]-VASc score may be a good risk marker in COVID patients but does not predict their embolic risk.
Keywords: Atrial fibrillation; Bleeding; CHA(2)DS(2)-VASc; COVID-19; Fibrilaci?n auricular; Hemorragia; Mortalidad; Mortality; Prognosis; Pron?stico; Registro; Registry; SARS-CoV-2.
. 2021 Jan 13;S1885-5857(21)00001-3.
doi: 10.1016/j.rec.2020.12.009. Online ahead of print.
Atrial fibrillation in patients with COVID-19. Usefulness of the CHA [SUB]2[/SUB] DS [SUB]2[/SUB]-VASc score: an analysis of the international HOPE COVID-19 registry
[Article in English, Spanish]
Aitor Uribarri[SUP] 1 [/SUP], Iv?n J N??ez-Gil[SUP] 2 [/SUP], ?lvaro Aparisi[SUP] 3 [/SUP], Ram?n Arroyo-Espliguero[SUP] 4 [/SUP], Charbel Maroun Eid[SUP] 5 [/SUP], Rodolfo Romero[SUP] 6 [/SUP], V?ctor M Becerra-Mu?oz[SUP] 7 [/SUP], Gisela Feltes[SUP] 8 [/SUP], Mar?a Molina[SUP] 9 [/SUP], Marcos Garc?a-Aguado[SUP] 10 [/SUP], Enrico Cerrato[SUP] 11 [/SUP], Thamar Capel-Astrua[SUP] 12 [/SUP], Emilio Alfonso-Rodr?guez[SUP] 13 [/SUP], Alex F Castro-Mej?a[SUP] 14 [/SUP], Sergio Raposeiras-Roub?n[SUP] 15 [/SUP], Carolina Espejo[SUP] 16 [/SUP], Nerea P?rez-Sol?[SUP] 17 [/SUP], Alfredo Barjard?[SUP] 18 [/SUP], Francisco Mar?n[SUP] 19 [/SUP], ?scar Fabregat-Andr?s[SUP] 20 [/SUP], Fabrizio D'ascenzo[SUP] 21 [/SUP], Francesco Santoro[SUP] 22 [/SUP], Ibrahim Akin[SUP] 23 [/SUP], Vicente Estrada[SUP] 2 [/SUP], Antonio Fern?ndez-Ortiz[SUP] 2 [/SUP], Carlos Macaya[SUP] 2 [/SUP], HOPE COVID-19 investigators
Affiliations
- PMID: 33583755
- DOI: 10.1016/j.rec.2020.12.009
Abstract
Introduction and objectives: Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2. Atrial fibrillation (AF) is common in acute situations, where it is associated with more complications and higher mortality.
Methods: Analysis of the international HOPE registry (NCT04334291). The objective was to assess the prognostic information of AF in COVID-19 patients. A multivariate analysis and propensity score matching were performed to assess the relationship between AF and mortality. We also evaluated the impact on mortality and embolic events of the CHA[SUB]2[/SUB]DS[SUB]2[/SUB]-VASc score in these patients.
Results: Among 6217 patients enrolled in the HOPE registry, 250 had AF (4.5%). AF patients had a higher prevalence of cardiovascular risk factors and comorbidities. After propensity score matching, these differences were attenuated. Despite this, patients with AF had a higher incidence of in-hospital complications such as heart failure (19.3% vs 11.6%, P=.021) and respiratory insufficiency (75.9% vs 62.3%, P=.002), as well as a higher 60-day mortality rate (43.4% vs 30.9%, P=.005). On multivariate analysis, AF was independently associated with higher 60-day mortality (hazard ratio, 1.234; 95%CI, 1.003-1.519). CHA[SUB]2[/SUB]DS[SUB]2[/SUB]-VASc score acceptably predicts 60-day mortality in COVID-19 patients (area ROC, 0.748; 95%CI, 0.733-0.764), but not its embolic risk (area ROC, 0.411; 95%CI, 0.147-0.675).
Conclusions: AF in COVID-19 patients is associated with a higher number of complications and 60-day mortality. The CHA[SUB]2[/SUB]DS[SUB]2[/SUB]-VASc score may be a good risk marker in COVID patients but does not predict their embolic risk.
Keywords: Atrial fibrillation; Bleeding; CHA(2)DS(2)-VASc; COVID-19; Fibrilaci?n auricular; Hemorragia; Mortalidad; Mortality; Prognosis; Pron?stico; Registro; Registry; SARS-CoV-2.