New-onset atrial fibrillation predicts poor prognosis in critically ill COVID-19 patients

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background/Introduction The association between new-onset atrial fibrillation (AF) and prognosis in critically ill non-COVID-19 patients and non-critically ill patients has been studied, but few studies reflect the reality of COVID-19 patients admitted to a general intensive care unit (ICU). Purpose This study sought to investigate the relationship between new-onset AF in COVID-19 patients admitted to an ICU and prognosis. Methods We retrospectively analyzed patients consecutively admitted to an ICU with COVID-19, with a median follow-up of 10 months. Two groups were identified, with new-onset AF and without new-onset AF. Groups were compared, with special interest regarding ICU mortality, duration of mechanical ventilation, in-hospital diagnosis of heart failure, NT-proBNP value in the first 48 hours after admission, and length of hospitalization. Mortality rate and re-hospitalization during follow-up were compared. Results From a total of 219 patients, AF was identified in 17.8% (n=39) of patients, of whom 69.2% (n=27) presented new-onset AF. Patients with new-onset AF were older (66.4 ±9.0 vs 61.5 ±12.2, p <0.001), with no differences regarding sex distribution. During hospitalization, patients with new-onset AF presented more often with new-onset heart failure (33.3% vs 6.3%, p <0.001), had a longer duration of mechanical ventilation (19.5 ±11 vs 9 ±12 days, p <0.001), longer ICU length of stay (20 ±12 vs 12 ±10 days, p<0.001), higher ICU mortality rate (55.6% vs 29.3%, p=0.006), and higher global mortality (55.6% vs 33.0%, p=0.022). Re-hospitalization rates were similar among groups (7.4% vs 6.3%, p=0.686). NT-proBNP in the first 48 hours was not statistically different among groups, although clinically new-onset AF patients presented higher values [median 1372 (IQR 3664) vs 246 (IQR 893), p=0.455). Main results are presented in Table 1. In multivariate logistic regression, after adjustment for age and APACHE II score, new-onset AF was identified as an independent predictor of ICU mortality (OR=2.475, 95% CI 1.05-5.84, p=0.039). Conclusion(s) The present study shows that new-onset AF in critically ill patients is not a trivial phenomenon and is closely related to the risk of death and worse in-hospital outcomes.