Harrison Stephanie L, Fazio-Eynullayeva Elnara, Lane Deirdre A, Underhill Paula, Lip Gregory Y H
Liverpool Centre for Cardiovascular Science University of Liverpool and Liverpool Heart & Chest Hospital Liverpool UK.
Cardiovascular and Metabolic Medicine Institute of Life Course and Medical Sciences University of Liverpool Liverpool UK.
J Arrhythm. 2020 Dec 11;37(1):231-237. doi: 10.1002/joa3.12458. eCollection 2021 Feb.
BACKGROUND: There are limited data on the outcomes of adults with coronavirus disease 2019 (COVID-19) and atrial fibrillation (AF). The objectives were to (i) examine associations between AF, 30-day thromboembolic events and mortality in adults with COVID-19 and (ii) examine associations between COVID-19, 30-day thromboembolic events and mortality in adults with AF. METHODS: A study was conducted using a global federated health research network. Adults aged ≥50 years who presented to 41 participating healthcare organizations between 20 January 2020 and 1 September 2020 with COVID-19 were included. RESULTS: For the first objective, 6589 adults with COVID-19 and AF were propensity score matched for age, gender, race, and comorbidities to 6589 adults with COVID-19 without AF. The survival probability was significantly lower in adults with COVID-19 and AF compared to matched adults without AF (82.7% compared to 88.3%, Log-Rank test < .0001; Risk Ratio (95% confidence interval) 1.61 (1.46, 1.78)) and risk of thromboembolic events was higher in patients with AF (9.9% vs 7.0%, Log-Rank test < .0001; Risk Ratio (95% confidence interval) 1.41 (1.26, 1.59)). For the second objective, 2454 adults with AF and COVID-19 were propensity score matched to 2454 adults with AF without COVID-19. The survival probability was significantly lower for adults with AF and COVID-19 compared to adults with AF without COVID-19, but there was no significant difference in risk of thromboembolic events. CONCLUSIONS: AF could be an important risk factor for short-term mortality with COVID-19, and COVID-19 may increase risk of short-term mortality amongst adults with AF.
背景：关于2019冠状病毒病（COVID-19）成年患者合并心房颤动（AF）的预后数据有限。目的是：（i）研究COVID-19成年患者中AF、30天血栓栓塞事件与死亡率之间的关联；（ii）研究AF成年患者中COVID-19、30天血栓栓塞事件与死亡率之间的关联。 方法：利用全球联合健康研究网络开展了一项研究。纳入了2020年1月20日至2020年9月1日期间前往41家参与研究的医疗机构就诊且年龄≥50岁的COVID-19成年患者。 结果：对于第一个目标，6589例合并COVID-19和AF的成年患者按照年龄、性别、种族和合并症进行倾向评分匹配，与6589例未合并AF的COVID-19成年患者进行比较。合并COVID-19和AF的成年患者的生存概率显著低于匹配的未合并AF的成年患者（分别为82.7%和88.3%，对数秩检验<0.0001；风险比（95%置信区间）为1.61（1.46，1.78）），AF患者发生血栓栓塞事件的风险更高（分别为9.9%和7.0%，对数秩检验<0.0001；风险比（95%置信区间）为1.41（1.26，1.59））。对于第二个目标，2454例合并AF和COVID-19的成年患者按照倾向评分匹配，与2454例未合并COVID-19的AF成年患者进行比较。合并AF和COVID-19的成年患者的生存概率显著低于未合并COVID-19的AF成年患者，但血栓栓塞事件风险无显著差异。 结论：AF可能是COVID-19短期死亡的重要危险因素，而COVID-19可能增加AF成年患者的短期死亡风险。
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