Geriatric Intensive Care Unit and Geriatric Arrhythmia Unit, Department of Experimental and Clinical Medicine, University of Florence and AOU Careggi, Florence, Italy.
Geriatrics Division, Department of Medicine (DIMED), University of Padua, Padua, Italy.
Thromb Haemost. 2022 Jan;122(1):105-112. doi: 10.1055/a-1503-3875. Epub 2021 Jun 18.
Atrial fibrillation (AF), the most frequent arrhythmia of older patients, associates with serious thromboembolic complications and high mortality. Coronavirus disease 2019 (COVID-19) severely affects aged subjects, determining an important prothrombotic status. The aim of this study was to evaluate mortality-related factors in older AF patients with COVID-19.
Between March and June 2020, we enrolled ≥60 year-old in-hospital COVID-19 patients ( 806) in GeroCovid, a multicenter observational study promoted by the Italian Society of Gerontology and Geriatric Medicine.
The prevalence of AF was 21.8%. In-hospital mortality was higher in the AF group (36.9 vs. 27.5%, = 0.015). At admission, 51.7, 10.2, and 38.1% of AF cases were taking, respectively, oral anticoagulants (OACs), antiplatelet agents, and no antithrombotic therapy. During hospitalization, 51% patients switched to low-molecular-weight heparins. AF patients who survived were younger (81 ± 8 vs. 84 ± 7 years; = 0.002) and had a lower CHADS-VASc score (3.9 ± 1.6 vs. 4.4 ± 1.3; = 0.02) than those who died. OAC use before (63.1 vs. 32.3%; < 0.001) and during hospitalization (34.0 vs. 12.7%; = 0.002) was higher among survivors. At multivariable analysis, lower age, higher self-sufficiency, less severe initial COVID-19 presentation, and the use of vitamin K antagonists (odds ratio [OR] = 0.16, 95% confidence interval [CI]: 0.03-0.84) or direct OACs (OR = 0.22, 95% CI: 0.08-0.56) at admission, or the persistence of OAC during hospitalization (OR = 0.05, 95% CI: 0.01-0.24), were associated with a lower chance of in-hospital death.
AF is a prevalent and severe condition in older COVID-19 patients. Advanced age, dependency, and relevant clinical manifestations of disease characterized a worse prognosis. Preadmission and in-hospital anticoagulant therapies were positively associated with survival.
心房颤动（房颤）是老年患者最常见的心律失常，与严重的血栓栓塞并发症和高死亡率有关。2019 年冠状病毒病（COVID-19）严重影响老年患者，导致重要的促血栓形成状态。本研究旨在评估 COVID-19 老年房颤患者的死亡率相关因素。
2020 年 3 月至 6 月期间，我们在意大利老年医学和老年病学会发起的多中心观察性研究 GeroCovid 中招募了≥60 岁的住院 COVID-19 患者（806 名）。
房颤的患病率为 21.8%。房颤组的院内死亡率较高（36.9%比 27.5%， = 0.015）。入院时，分别有 51.7%、10.2%和 38.1%的房颤患者服用口服抗凝剂（OACs）、抗血小板药物和无抗血栓治疗。住院期间，51%的患者转为低分子肝素。存活的房颤患者更年轻（81±8 岁比 84±7 岁； = 0.002），CHADS-VASc 评分较低（3.9±1.6 比 4.4±1.3； = 0.02）。与死亡患者相比，入院前（63.1%比 32.3%； < 0.001）和住院期间（34.0%比 12.7%； = 0.002）使用 OAC 的比例更高。多变量分析显示，较低的年龄、较高的自理能力、较轻的初始 COVID-19 表现以及入院时使用维生素 K 拮抗剂（比值比 [OR] = 0.16，95%置信区间 [CI]：0.03-0.84）或直接 OAC（OR = 0.22，95% CI：0.08-0.56）或住院期间持续使用 OAC（OR = 0.05，95% CI：0.01-0.24）与院内死亡的几率较低相关。
房颤是老年 COVID-19 患者的一种常见且严重的疾病。高龄、依赖和疾病的相关临床表现预示着预后更差。入院前和住院期间的抗凝治疗与生存呈正相关。
