Babb Miles, Stevenson Kurt
Internal Medicine, Boise Internal Medicine Residency, University of Washington, Boise, USA.
Infectious Diseases, Boise Veterans Affairs Medical Center, Boise, USA.
Cureus. 2024 Feb 9;16(2):e53909. doi: 10.7759/cureus.53909. eCollection 2024 Feb.
Anticoagulation (AC) strategy in new-onset atrial fibrillation (NOAF) secondary to other illnesses has not been broadly studied, and society-level guidance does not provide a strong recommendation regarding outpatient continuation upon discharge. Our study focused specifically on patients experiencing NOAF secondary to COVID-19. It sought to understand whether our facility's rounding prescribers were continuing patients on AC at discharge, the presence of arrhythmia at one-year follow-up, and to observe the risk of adverse outcomes in light of this unique precipitant. A retrospective cohort analysis and chart review were conducted of 231 consecutive inpatients during the initial 19 months of the COVID-19 pandemic. Eighteen patients experiencing NOAF with an average calculated CHADS-VASc score of four were included in the cohort. Four patients (22%) died during hospitalization and 14 patients were discharged. Twelve of fourteen patients (86%) were discharged on AC, and eight remained adherent at follow-up. Two discharged patients died of unknown causes prior to follow-up. At follow-up, which occurred at a median of 1.2 years, 25% of the surviving cohort remained in atrial fibrillation (AF). No major bleeding events were recorded during the studied period. This retrospective analysis of a small sample of patients admitted to a single medical center for COVID-19 and experiencing NOAF demonstrates that local prescribers are continuing AC at discharge, that the rate of recurrence of AF is similar to onset in non-COVID illness at one year, and that risk of death approximated that of COVID-19 itself rather than NOAF.
继发于其他疾病的新发房颤（NOAF）的抗凝（AC）策略尚未得到广泛研究，社会层面的指南也未就出院后门诊继续使用抗凝药物给出有力推荐。我们的研究专门针对继发于新型冠状病毒肺炎（COVID-19）的NOAF患者。该研究旨在了解我们机构的查房开方医生是否在患者出院时继续为其开具AC药物、在一年随访时心律失常的情况，并鉴于这一独特的诱发因素观察不良结局的风险。在COVID-19大流行的最初19个月期间，对231例连续住院患者进行了回顾性队列分析和病历审查。该队列纳入了18例平均计算CHADS-VASc评分为4分的NOAF患者。18例患者中有4例（22%）在住院期间死亡，14例患者出院。14例出院患者中有12例（86%）出院时使用了AC药物，8例在随访时仍坚持用药。2例出院患者在随访前死于不明原因。在中位时间为1.2年的随访中，存活队列中有25%仍处于房颤（AF）状态。在研究期间未记录到重大出血事件。这项对因COVID-19入住单一医疗中心且患有NOAF的一小部分患者的回顾性分析表明，当地开方医生在患者出院时继续使用AC药物，AF复发率与非COVID疾病一年时的发病率相似，死亡风险接近COVID-19本身而非NOAF。
