Hazardous Area Response Team Paramedic, South Western Ambulance Service NHS Foundation Trust, North Bristol Operations Centre, Bristol, UK.
Senior Lecturer in Health Statistics, University of the West of England, Bristol, UK.
Ann Noninvasive Electrocardiol. 2024 Nov;29(6):e70016. doi: 10.1111/anec.70016.
While COVID-19 is predominantly a respiratory disease, cardiovascular complications occur and are associated with worse outcomes. Electrocardiogram (ECG) abnormalities are frequently observed in hospitalized COVID-19 patients, some of which are associated with increased mortality. It is unclear whether ECG abnormalities occurring before hospitalization are associated with increased mortality. This quantitative systematic literature review aims to determine which ECG changes occurring before hospitalization are associated with mortality and discuss whether these findings can aid the assessment of patients and decision-making in the pre-hospital environment.
A systematic search of the following digital databases was conducted: CINAL, PUBMED, MEDLINE, and Coronavirus Research Database. Eight cohort studies (primary papers) including COVID-19 patients with ECGs taken in the Emergency Department before hospitalization were selected for quantitative synthesis and results were obtained for the prevalence of ECG changes among survivors compared with non-survivors. Odds and hazard ratios for ECG abnormalities associated with mortality were also collected and compared.
Identification of ECG abnormalities on pre-hospitalization ECG is associated with increased mortality in COVID-19 patients. These ECG abnormalities include non-sinus rhythm, QTc prolongation, left bundle branch block, axis deviation, atrial fibrillation, atrial flutter, right ventricular strain patterns, ST segment changes, T wave abnormalities, and evidence of left ventricular hypertrophy.
Electrocardiogram assessment in the pre-hospital environment may be beneficial when assessing COVID-19 patients and could help identify patients at increased risk of mortality.
虽然 COVID-19 主要是一种呼吸道疾病，但心血管并发症会发生，并与更差的预后相关。住院 COVID-19 患者经常观察到心电图 (ECG) 异常，其中一些与死亡率增加有关。尚不清楚住院前发生的 ECG 异常是否与死亡率增加相关。本定量系统文献综述旨在确定住院前发生的哪些 ECG 变化与死亡率相关，并讨论这些发现是否可以帮助评估患者并在院前环境中做出决策。
对以下数字数据库进行了系统搜索：CINAL、PUBMED、MEDLINE 和冠状病毒研究数据库。选择了八项队列研究（主要论文），包括在住院前在急诊科进行的 COVID-19 患者心电图，以进行定量综合，并获得幸存者与非幸存者之间 ECG 变化的患病率。还收集并比较了与死亡率相关的 ECG 异常的优势比和风险比。
在 COVID-19 患者中，院前心电图上识别出的 ECG 异常与死亡率增加相关。这些 ECG 异常包括非窦性节律、QTc 延长、左束支传导阻滞、轴偏移、心房颤动、心房扑动、右心室应变模式、ST 段变化、T 波异常和左心室肥厚的证据。
在评估 COVID-19 患者时，院前环境中的心电图评估可能是有益的，并有助于识别死亡率增加风险较高的患者。
