Background: Atrial fibrillation (AF) is condition associated with increased risk of death in multiple populations (1). The association between AF and COVID-19 infection has started to be explored, but largely in specific geographic locations and/or within the context of the hospitalization (2). By understanding the relationship between COVID-19 and AF, providers may be better supported in the process of triaging these patients and preparing for possible decompensation. In this study, we aim to examine multiple known risk factors for severity of COVID-19 infection with presence of AF and the CHA2DS2-VASc score in relation to both escalations of care and in-hospital mortality.

Methods: The study is designed as a retrospective cohort study of encounters at a large urban academic tertiary referral hospital of adult COVID-19 positive patients admitted between March 2020 and September 2021. Data was extracted directly from the electronic health record. Primary outcomes were escalation to the intensive care unit at any time during the hospitalization and in-hospital mortality. In addition to AF and CHA2DS2-VASc, variables known to be associated with COVID-19 severity of illness were also assessed, including age, gender, race, chronic kidney disease (CKD), diabetes mellitus (DM), and obesity. Each variable was assessed with univariate analysis for each of the two primary outcomes.

Results: A total of 41,245 patients were admitted during the study timeframe with 2554 (6.2%) having positive COVID-19 test results during the encounter. Of positive patients, 6% were documented with AF, with additional demographic variables in Table 1. There were 705 (27.6%) encounters with escalations of care and 323 (12.6%) patients died while hospitalized with COVID-19. Atrial fibrillation had the strongest correlation with both escalations of care and in-hospital mortality (Table 2). The CHA2DS2-VASc was also a statistically significant indicator of both outcomes for the entire population.

Conclusions: Atrial fibrillation was significantly associated with escalations of care and in-patient mortality in COVID-19 patients at the study institution. The CHA2DS2-VASc score was found to be a potential risk stratification tool across the COVID-19 population, regardless of presence of atrial fibrillation. Further evaluation of the risk score in a broader population would need to be made to determine generalizability.

IMAGE 1: Table 1

IMAGE 2: Table 2