Atrial fibrillation and COVID-19 in older patients: how disability contributes to shape the risk profile. An analysis of the GeroCovid registry

Abstract

Background and aims: Atrial fibrillation (AF) is often complicated by disabling conditions in the elderly. COVID-19 has high mortality in older people. This study aimed at evaluating the relationship of pre-infection AF with characteristics and survival of older COVID-19 patients.

Methods: We retrospectively analyzed inpatients aged ≥ 60 years enrolled in GeroCovid Observational, a multicenter registry endorsed by the Italian and the Norwegian Societies of Gerontology and Geriatrics. Pre-COVID-19 sociodemographic, functional, and medical data were systematically collected, as well as in-hospital mortality.

Results: Between March and June 2020, 808 COVID-19 subjects were enrolled (age 79 ± 9 years; men 51.7%). The prevalence of AF was 21.8%. AF patients were older (82 ± 8 vs. 77 ± 9 years, p < 0.001), had a higher CHA2DS2-VASc score (4.1 ± 1.5 vs. 3.2 ± 1.5, p < 0.001) and were more likely to present almost all comorbidities. At multivariable analysis, advanced age, white blood cell count, the presence of heart and peripheral artery diseases were significantly associated with the presence of AF. In-hospital mortality was higher in AF patients (36.9 vs. 27.5%; OR = 1.55, 95% CI = 1.09-2.20; p = 0.015). A decision tree analysis showed that, in AF subjects, preserved functional status at admission was the most important factor associated with survival. In patients without AF, baseline COVID-19 severity was the most relevant variable related to clinical prognosis.

Conclusions: AF is frequent in older patients with COVID-19, in whom it associates with clinical complexity and high mortality. Pre-infection disability shapes the prognosis of this extremely vulnerable segment of hospitalized subjects.

Clinical trial registration: GeroCovid Observational was registered at www.clinicaltrials.gov (NCT04379440).

Keywords: Atrial fibrillation; COVID-19; Disability; Older patients; Oral anticoagulants; Prognosis.

Conflict of interest statement

The authors have no conflicts of interest to declare that are relevant to the content of this article.

© 2021. The Author(s), under exclusive licence to Springer Nature Switzerland AG.

Figures

Fig. 1

Prevalence of comorbid conditions by AF status in the GeroCovid population. CHF signs and symptoms of chronic heart failure, CKD chronic kidney disease, COPD chronic obstructive pulmonary disease, dis. disease, PAD peripheral artery disease

Fig. 2

Tree-based classification model for in-hospital mortality in the GeroCovid population assuming AF at baseline as the first clustering node. AF atrial fibrillation, Age_scale age, COVID_19_WHO_Status_baseline WHO classification of severity of COVID-19, Mild_No O2 mild disease with no oxygen support needed, Mild_O2 Mask_NP mild disease with low-flow oxygen support (oxygen mask or nasal prongs) needed, Severe_Critical disease needing high-flow oxygen support, non-invasive or invasive mechanical ventilation, or organ support