Romiti Giulio Francesco, Corica Bernadette, Lip Gregory Y H, Proietti Marco
Department of Translational and Precision Medicine, Sapienza-University of Rome, 00161 Rome, Italy.
Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool 14 3PE, UK.
J Clin Med. 2021 Jun 4;10(11):2490. doi: 10.3390/jcm10112490.
In patients with COVID-19, cardiovascular complications are common and associated with poor prognosis. Among these, an association between atrial fibrillation (AF) and COVID-19 has been described; however, the extent of this relationship is unclear. The aim of this study is to investigate the epidemiology of AF in COVID-19 patients and its impact on all-cause mortality.
A systematic review and meta-analysis were performed and reported according to PRISMA guidelines, and a protocol for this study was registered on PROSPERO (CRD42021227950). PubMed and EMBASE were systematically searched for relevant studies. A random-effects model was used to estimate pooled odds ratios (OR) and 95% confidence intervals (CI).
Overall, 31 studies were included in the analysis, with a total number of 187,716 COVID-19 patients. The prevalence of AF was found to be as high as 8% of patients with COVID-19 (95% CI: 6.3-10.2%, 95% prediction intervals (PI): 2.0-27.1%), with a high degree of heterogeneity between studies; a multiple meta-regression model including geographical location, age, hypertension, and diabetes showed that these factors accounted for more than a third of the heterogeneity. AF COVID-19 patients were less likely to be female but more likely older, hypertensive, and with a critical status than those without AF. Patients with AF showed a significant increase in the risk of all-cause mortality (OR: 3.97, 95% CI: 2.76-5.71), with a high degree of heterogeneity. A sensitivity analysis focusing on new-onset AF showed the consistency of these results.
Among COVID-19 patients, AF is found in 8% of patients. AF COVID-19 patients are older, more hypertensive, and more likely to have a critical status. In COVID-19 patients, AF is associated with a 4-fold higher risk of death. Further studies are needed to define the best treatment strategies to improve the prognosis of AF COVID-19 patients.
在新型冠状病毒肺炎（COVID-19）患者中，心血管并发症很常见且与预后不良相关。其中，心房颤动（AF）与COVID-19之间的关联已有描述；然而，这种关系的程度尚不清楚。本研究的目的是调查COVID-19患者中AF的流行病学及其对全因死亡率的影响。
按照PRISMA指南进行系统评价和荟萃分析，并在PROSPERO（CRD42021227950）上注册了本研究方案。系统检索PubMed和EMBASE以获取相关研究。采用随机效应模型估计合并比值比（OR）和95%置信区间（CI）。
总体而言，分析纳入了31项研究，共187716例COVID-19患者。发现AF在COVID-19患者中的患病率高达8%（95%CI：6.3-10.2%，95%预测区间（PI）：2.0-27.1%），各研究之间存在高度异质性；包括地理位置、年龄、高血压和糖尿病的多元Meta回归模型显示，这些因素占异质性的三分之一以上。与无AF的患者相比，AF COVID-19患者女性比例较低，但年龄较大、患有高血压且病情危重的可能性更高。AF患者的全因死亡风险显著增加（OR：3.97，95%CI：2.76-5.71），存在高度异质性。聚焦新发AF的敏感性分析显示了这些结果的一致性。
在COVID-19患者中，8%的患者存在AF。AF COVID-19患者年龄较大、高血压患病率更高且病情危重的可能性更大。在COVID-19患者中，AF与死亡风险高4倍相关。需要进一步研究以确定改善AF COVID-19患者预后的最佳治疗策略。
