Atrial fibrillation in patients with COVID-19. Usefulness of the CHA(2)DS(2)-VASc score: an analysis of the international HOPE COVID-19 registry

Introduction and objectives: Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2. Atrial fibrillation (AF) is common in acute situations, where it is associated with more complications and higher mortality. Methods: Analysis of the international HOPE registry (NCT04334291). The objective was to assess the prognostic information of AF in COVID-19 patients. A multivariate analysis and propensity score matching were performed to assess the relationship between AF and mortality. We also evaluated the impact on mortality and embolic events of the CHA(2)DS(2)-VASc score in these patients. Results: Among 6217 patients enrolled in the HOPE registry, 250 had AF (4.5%). AF patients had a higher prevalence of cardiovascular risk factors and comorbidities. After propensity score matching, these differences were attenuated. Despite this, patients with AF had a higher incidence of in-hospital complications such as heart failure (19.3% vs 11.6%, P= .021) and respiratory insufficiency (75.9% vs 62.3%, P = .002), as well as a higher 60-day mortality rate (43.4% vs 30.9%, P = .005). On multivariate analysis, AF was independently associated with higher 60-day mortality (hazard ratio, 1.234; 95%Cl, 1.003-1.519). CHA(2)DS(2)-VASc score acceptably predicts 60-day mortality in COVID-19 patients (area ROC, 0.748; 95%CI, 0.733-0.764), but not its embolic risk (area ROC, 0.411; 95%Cl, 0.147-0.675). Conclusions: AF in COVID-19 patients is associated with a higher number of complications and 60-day mortality. The CHA(2)DS(2)-VASc score may be a good risk marker in COVID patients but does not predict their embolic risk. (C) 2021 Sociedad Espanola de Cardiologia. Published by Elsevier Espana, S.L.U. All rights reserved.

Automated summary

Atrial fibrillation (AF) in COVID-19 patients is associated with a higher number of complications and a higher 60-day mortality rate. The CHA(2)DS(2)-VASc score may be a good risk marker in COVID patients but does not predict their embolic risk.