Department of Pharmacy, Affiliated Hospital of Shaoxing University, Shao Xing, Zhejiang, China.
Department of Cardiology, Affiliated Hospital of Shaoxing University, Shao Xing, Zhejiang, China.
PeerJ. 2024 Oct 16;12:e18330. doi: 10.7717/peerj.18330. eCollection 2024.
There exist serious cardiovascular complications subsequent to SARS-Cov2 infection (COVID-19); however, the association between COVID-19 and atrial fibrillation (AF) remains to be elucidated. We aimed to assess the prevalence of AF among COVID-19 patients and its associated risk of death.
The present systematic review was performed in accordance with the PRISMA guidelines. The protocol was registered with CRD42022306523. A comprehensive literature search was performed across PubMed, Embase, and Cochrane databases to identify studies reporting on the prevalence of pre-existing or new-onset fibrillation (AF), and/or the associated clinical outcomes in patients with COVID-19 from January 2020 to December 2023. The random-effect model was used to estimate the prevalence of AF and its related mortality.
A total of 80 studies, including 39,062,868 COVID-19 patients, were identified in the present investigation. The prevalence rates of pre-existing AF or new-onset AF were 10.5% (95% CI [9.3-11.7%]) or 10.3% (95% CI [6.2-14.5%]), respectively. Subgroup analysis revealed a two fold higher incidence of AF in older patients (≥65 years) compared to younger patients (<65 years) (14.4% . 6.4%). The highest rate of AF was observed in Europeans (10.7%, 95% CI [10.2-11.2%]), followed by Northern Americans (10.0%, 95% CI [8.2-11.7%]), while Asians demonstrated a lower prevalence (2.7%, 95% CI [2.2-3.3%]). Notably, severe COVID-19 patients displayed a significantly elevated prevalence of AF at 14.l% (95% CI [13.3-14.9%]), which was approximately 2.5-fold higher than that in non-severe patients (5.2%, 95% CI [4.8-5.5%]). Both pre-existing (HR: 1.83, 95% CI [1.49-2.17]) and new-onset AF (HR: 3.47, 95% CI [2.26-5.33]) were associated with an increased mortality risk among COVID-19 patients. Furthermore, the effect on mortality risk was more significant in Asians (HR: 5.33, 95% CI [1.62-9.04]), compared to Europeans (HR: 1.68, 95% CI [1.24-2.13]) and North Americans (HR: 2.01, 95% CI [1.18-2.83]).
This study comprehensively investigated the association between AF and COVID-19 in a real-world setting. Notably, a high prevalence of AF was observed among older individuals, severe COVID-19 patients, and in Europe and Northern America. Moreover, co-existing AF was found to be associated with an increased risk for mortality. Further investigations are warranted to improve the management and outcomes of COVID-19 patients with AF.
SARS-CoV-2 感染（COVID-19）后存在严重的心血管并发症，但 COVID-19 与心房颤动（AF）之间的关系仍有待阐明。我们旨在评估 COVID-19 患者中 AF 的患病率及其相关的死亡风险。
本系统评价按照 PRISMA 指南进行。方案已在 CRD42022306523 注册。通过 PubMed、Embase 和 Cochrane 数据库进行全面的文献检索，以确定自 2020 年 1 月至 2023 年 12 月期间报告 COVID-19 患者中预先存在或新发的房颤（AF）的患病率及其相关临床结局的研究。使用随机效应模型来估计 AF 的患病率及其相关死亡率。
本研究共纳入了 80 项研究，包括 39062868 例 COVID-19 患者。预先存在的 AF 或新发的 AF 的患病率分别为 10.5%（95%CI [9.3-11.7%]）或 10.3%（95%CI [6.2-14.5%]）。亚组分析显示，老年患者（≥65 岁）AF 的发病率是年轻患者（<65 岁）的两倍（14.4%比 6.4%）。AF 的最高发病率见于欧洲人（10.7%，95%CI [10.2-11.2%]），其次是北美（10.0%，95%CI [8.2-11.7%]），而亚洲人则较低（2.7%，95%CI [2.2-3.3%]）。值得注意的是，严重 COVID-19 患者的 AF 患病率显著升高，为 14.1%（95%CI [13.3-14.9%]），约是非严重患者的 2.5 倍（5.2%，95%CI [4.8-5.5%]）。预先存在的（HR：1.83，95%CI [1.49-2.17]）和新发的（HR：3.47，95%CI [2.26-5.33]）AF 均与 COVID-19 患者的死亡率风险增加相关。此外，AF 对死亡率风险的影响在亚洲人（HR：5.33，95%CI [1.62-9.04]）中比欧洲人（HR：1.68，95%CI [1.24-2.13]）和北美人（HR：2.01，95%CI [1.18-2.83]）更为显著。
本研究在真实世界环境中综合研究了 AF 与 COVID-19 之间的关系。值得注意的是，老年患者、严重 COVID-19 患者以及欧洲和北美地区的 AF 患病率较高。此外，合并 AF 与死亡率风险增加相关。需要进一步的研究来改善 COVID-19 合并 AF 患者的管理和结局。
