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Vaidean GD, Rubens M, Ramamoorthy V, Saxena A, Appunni S, Khosla AA, Doke M, Körfer D, Chaparro S, Jimenez J. Prevalence and outcomes of atrial fibrillation in patients hospitalized with COVID-19. Curr Med Res Opin 2024; 40:1477-1481. [PMID: 39034775 DOI: 10.1080/03007995.2024.2378179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 07/01/2024] [Accepted: 07/05/2024] [Indexed: 07/23/2024]
Abstract
OBJECTIVE Atrial fibrillation (AF) is a common arrhythmia in patients at high cardiovascular risk. COVID-19 patients with underlying cardiovascular disease are at increased risk of poor clinical outcomes. In this study, we aimed to determine hospital outcomes among patients admitted with AF and COVID-19 infection. METHODS We conducted a retrospective analysis using the 2020 California State Inpatient data, including all COVID-19 hospitalizations of individuals aged ≥18. Primary outcomes were in-hospital mortality, prolonged length of stay (above the 75th percentile), vasopressor use, mechanical ventilation, and ICU admission. We compared adverse hospital outcomes between those with and without AF and used multivariable logistic regression to adjust for confounders. RESULTS This analysis included 94,114 COVID-19 hospitalizations, of which 9391 (10.0%) had AF. Patients with COVID-19 and AF had higher rates of adverse outcomes, including mortality (27.2% vs. 9.6%, p < .001), prolonged length of stay (40.0% vs. 27.1%, p < .001), vasopressor use (4.4% vs. 1.9%, p < .001), mechanical ventilation (19.0% vs. 9.1%, p < .001), and ICU admission (18.4% vs. 8.8%, p < .001) After multivariable adjustment, the odds of adverse outcomes remained significantly higher, including mortality adjusted odds ratio [OR], 2.04, 95% CI: 1.92-2.16), prolonged length of stay (aOR, 1.37, 95% CI: 1.31-1.44), vasopressor use (aOR, 1.98, 95% CI: 1.86-2.11), mechanical ventilation (aOR, 1.95, 95% CI: 1.72-2.20), and ICU admission (aOR, 2.01, 95% CI: 1.88-2.15). CONCLUSION COVID-19 hospitalized patients frequently have underlying AF, which confers a higher risk of adverse hospital outcomes and mortality, even after adjusting for baseline comorbidities. Heightened awareness is needed in the treatment of hospitalized COVID-19 patients with AF.
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Affiliation(s)
- Georgeta D Vaidean
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Muni Rubens
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
- Department of Health Science, Universidad Espíritu Santo, Samborondón, Ecuador
| | | | - Anshul Saxena
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
- Center for Advanced Analytics, Baptist Health South Florida, Miami, FL, USA
| | - Sandeep Appunni
- Department of Biochemistry, Government Medical College, Kozhikode, Kerala, India
| | - Atulya Aman Khosla
- Department of Internal Medicine, William Beaumont University Hospital, Royal Oak, MI, USA
| | - Mayur Doke
- Diabetes Research Institute, University of Miami, Miami, FL, USA
| | - Daniel Körfer
- Miami Cardiac & Vascular Institute, Baptist Health South Florida, Miami, FL, USA
| | - Sandra Chaparro
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
- Miami Cardiac & Vascular Institute, Baptist Health South Florida, Miami, FL, USA
| | - Javier Jimenez
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
- Miami Cardiac & Vascular Institute, Baptist Health South Florida, Miami, FL, USA
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Spruit JR, Jansen RWMM, de Groot JR, de Vries TAC, Hemels MEW, Douma RA, de Haan LR, Brinkman K, Moeniralam HS, de Kruif M, Dormans T, Appelman B, Reidinga AC, Rusch D, Gritters van den Oever NC, Schuurman RJ, Beudel M, Simsek S. Does atrial fibrillation affect prognosis in hospitalised COVID-19 patients? A multicentre historical cohort study in the Netherlands. BMJ Open 2023; 13:e071137. [PMID: 38070891 PMCID: PMC10729035 DOI: 10.1136/bmjopen-2022-071137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 10/09/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVES The aim of this multicentre COVID-PREDICT study (a nationwide observational cohort study that aims to better understand clinical course of COVID-19 and to predict which COVID-19 patients should receive which treatment and which type of care) was to determine the association between atrial fibrillation (AF) and mortality, intensive care unit (ICU) admission, complications and discharge destination in hospitalised COVID-19 patients. SETTING Data from a historical cohort study in eight hospitals (both academic and non-academic) in the Netherlands between January 2020 and July 2021 were used in this study. PARTICIPANTS 3064 hospitalised COVID-19 patients >18 years old. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was the incidence of new-onset AF during hospitalisation. Secondary outcomes were the association between new-onset AF (vs prevalent or non-AF) and mortality, ICU admissions, complications and discharge destination, performed by univariable and multivariable logistic regression analyses. RESULTS Of the 3064 included patients (60.6% men, median age: 65 years, IQR 55-75 years), 72 (2.3%) patients had prevalent AF and 164 (5.4%) patients developed new-onset AF during hospitalisation. Compared with patients without AF, patients with new-onset AF had a higher incidence of death (adjusted OR (aOR) 1.71, 95% CI 1.17 to 2.59) an ICU admission (aOR 5.45, 95% CI 3.90 to 7.61). Mortality was non-significantly different between patients with prevalent AF and those with new-onset AF (aOR 0.97, 95% CI 0.53 to 1.76). However, new-onset AF was associated with a higher incidence of ICU admission and complications compared with prevalent AF (OR 6.34, 95% CI 2.95 to 13.63, OR 3.04, 95% CI 1.67 to 5.55, respectively). CONCLUSION New-onset AF was associated with an increased incidence of death, ICU admission, complications and a lower chance to be discharged home. These effects were far less pronounced in patients with prevalent AF. Therefore, new-onset AF seems to represent a marker of disease severity, rather than a cause of adverse outcomes.
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Affiliation(s)
| | | | - Joris R de Groot
- Department of Cardiology, Heart Centre, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | | | - Martin E W Hemels
- Department of Cardiology, Rijnstate, Arnhem, Arnhem, Netherlands
- Department of Cardiology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Renee A Douma
- Vascular Medicine, Amsterdam University Medical Centers, Amsterdam, Netherlands
- Flevo Hospital, Almere, Netherlands
| | - Lianne R de Haan
- Flevo Hospital, Almere, Netherlands
- Medical Centre Alkmaar, Alkmaar, Netherlands
| | - Kees Brinkman
- Department of Internal Medicine, OLVG, Amsterdam, Netherlands
| | - Hazra S Moeniralam
- Vascular Medicine, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Martijn de Kruif
- Department of Pulmonary Medicine, Zuyderland Medical Centre Heerlen, Heerlen, Netherlands
| | - Tom Dormans
- Vascular Medicine, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Brent Appelman
- Amsterdam UMC Locatie Meibergdreef, Amsterdam, Netherlands
| | - Auke C Reidinga
- Vascular Medicine, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Daisy Rusch
- Research, Martini Ziekenhuis, Groningen, Netherlands
| | | | | | - Martijn Beudel
- Neurology, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Suat Simsek
- Department of Internal Medicine, Noordwest Ziekenhuisgroep, Alkmaar, Netherlands
- Department of Internal Medicine, Section of Endocrinology, Amsterdam UMC - Locatie VUMC, Amsterdam, Netherlands
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Fender AC. Recent highlights from the International Journal of Cardiology Heart & Vasculature on challenges for adequate stroke prevention in patients with atrial fibrillation. IJC HEART & VASCULATURE 2023; 48:101259. [PMID: 37663614 PMCID: PMC10469038 DOI: 10.1016/j.ijcha.2023.101259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Affiliation(s)
- Anke C. Fender
- Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany
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Saljic A, Heijman J, Dobrev D. Recent Advances in Antiarrhythmic Drug Therapy. Drugs 2023; 83:1147-1160. [PMID: 37540446 PMCID: PMC10462572 DOI: 10.1007/s40265-023-01923-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2023] [Indexed: 08/05/2023]
Abstract
Cardiac arrhythmias remain a common cause of death and disability. Antiarrhythmic drugs (AADs) and antiarrhythmic agents remain a cornerstone of current cardiac arrhythmia management, despite moderate efficacy and the potential for significant adverse proarrhythmic effects. Due to conceptual, regulatory and financial considerations, the number of novel antiarrhythmic targets and agents in the development pipeline has decreased substantially during the last few decades. However, several promising candidates remain and there are exciting developments in repurposing and reformulating already existing drugs for indications related to cardiac arrhythmias. This review discusses the key conceptual considerations for the development of new antiarrhythmic agents, summarizes new compounds and formulations currently in clinical development for rhythm control of atrial fibrillation, and highlights the potential for drug repurposing. Finally, future directions in AAD development are discussed. Together with an ever-increasing understanding of the molecular mechanisms underlying cardiac arrhythmias, these components support a cautiously optimistic outlook towards improved pharmacological treatment opportunities for patients suffering from cardiac arrhythmias.
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Affiliation(s)
- Arnela Saljic
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany
| | - Jordi Heijman
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Dobromir Dobrev
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
- Montréal Heart Institute and University de Montréal, Medicine and Research Center, Montréal, Canada.
- Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, USA.
- , Hufelandstrasse 55, 45122, Essen, Germany.
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Anouassi Z, Abril C, Ismail G, El Nekidy WS, Al-Hadeethi A, Bafadel A, Atallah B. A Case of Hemorrhagic Cholecystitis in a Patient on Apixaban After COVID-19 Infection. AMERICAN JOURNAL OF CASE REPORTS 2023; 24:e939677. [PMID: 37475204 PMCID: PMC10367937 DOI: 10.12659/ajcr.939677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 06/21/2023] [Accepted: 05/31/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND Hemorrhagic cholecystitis is a rare cause of abdominal pain, which can result from malignancy, bleeding, or trauma. The presentation, which includes right upper-quadrant pain, nausea, and vomiting, can overlap with other disease states, thereby rendering the diagnosis challenging. CASE REPORT We describe a patient taking apixaban wo had paroxysmal atrial fibrillation with history of joint pain on long-term steroids who developed hemorrhagic cholecystitis following an episode of pneumonia secondary to SARS-CoV-2 virus (COVID-19) infection. The hospital COVID-19 pneumonia protocol included the administration of steroids and symptomatic care. Following discharge, he presented to our hospital with a sudden onset of severe abdominal pain and distention accompanied by elevated liver enzymes and a low hemoglobin level of 78 g/L. Magnetic resonance cholangiopancreatography revealed a distended gallbladder and intraluminal layering, early subacute blood products, and increased wall thickness, which was thought to represent non-calcular hemorrhagic cholecystitis. Furthermore, a stable 18×16×20 mm cyst in the tail of the pancreas was also located posteriorly, with indentation to the splenic vein. The patient was managed conservatively, and the pain subsided on day 3 after admission. CONCLUSIONS Hemorrhagic cholecystitis is rarely reported with the use of the direct oral anticoagulants (DOACs). In our case the combination of a recent COVID-19 hospitalization, steroid use, and possible pancreatic cancer (CA 19-9 288.4 kU/L) may have contributed to such incidence in the setting of apixaban utilization; however, it is not possible to make definitive correlations. Investigating hemorrhagic cholecystitis in the setting of DOAC use in patients with multiple risk factors such as those that existed in our patient is imperative for proper diagnosis and management.
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Affiliation(s)
- Zohour Anouassi
- Department of Pharmacy Services, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Carlos Abril
- Department of Gastroenterology, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Ghanem Ismail
- Department of Cardiovascular Medicine, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Wasim S. El Nekidy
- Department of Pharmacy Services, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Abdullah Al-Hadeethi
- Department of Cardiovascular Medicine, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Ahmed Bafadel
- Department of Cardiovascular Medicine, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Bassam Atallah
- Department of Pharmacy Services, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA
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Kanuri SH, Jayesh Sirrkay P, Ulucay AS. COVID-19 HEART unveiling as atrial fibrillation: pathophysiology, management and future directions for research. Egypt Heart J 2023; 75:36. [PMID: 37120772 PMCID: PMC10149046 DOI: 10.1186/s43044-023-00359-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/22/2023] [Indexed: 05/01/2023] Open
Abstract
BACKGROUND COVID-19 infections are known to cause numerous systemic complications including cardiovascular disorders. In this regard, clinicians recently noticed that patients recovering from COVID-19 infections presented with diverse set of cardiovascular disorders in addition to those admitted to ICU (intensive care unit). COVID-19 heart has multifaceted presentation ranging from dysrhythmias, myocarditis, stroke, coronary artery disease, thromboembolism to heart failure. Atrial fibrillation is the most common cardiac arrhythmia among COVID-19 patients. In the background section, we briefly discussed epidemiology and spectrum of cardiac arrhythmias in COVID-19 patients. MAIN BODY In this state-of-the-art review we present here, we present the information regarding COVID-19-induced A-fib in sections, namely mechanism of action, clinical presentation, diagnosis and treatment. Unfortunately, its occurrence significantly increases the mortality and morbidity with a potential risk of complications such as cardiac arrest and sudden death. We included separate sections on complications including thromboembolism and ventricular arrhythmias. Since its mechanism is currently a gray area, we included a separate section on basic science research studies that are warranted in the future to comprehend its underlying pathogenic mechanisms. CONCLUSIONS Taken together, this review builds upon the current literature of COVID-19-induced A-fib, including pathophysiology, clinical presentation, treatment and complications. Furthermore, it provides recommendations for future research moving forward that can open avenues for developing novel remedies that can prevent as well as hasten clinical recovery of atrial fibrillation in COVID-19 patients.
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