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Rathore SS, Atulkar A, Remala K, Corrales VV, Farrukh AM, Puar RK, Yao SJN, Ganipineni VDP, Patel N, Thota N, Kumar A, Deshmukh A. A systematic review and meta-analysis of new-onset atrial fibrillation in the context of COVID-19 infection. J Cardiovasc Electrophysiol 2024; 35:478-487. [PMID: 38185923 DOI: 10.1111/jce.16169] [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: 10/17/2023] [Revised: 12/09/2023] [Accepted: 12/18/2023] [Indexed: 01/09/2024]
Abstract
New-onset atrial fibrillation (NOAF) in COVID-19 raises significant clinical and public health issues. This systematic review and meta-analysis aims to compile and analyze the current literature on NOAF in COVID-19 and give a more comprehensive understanding of the prevalence and outcomes of NOAF in COVID-19. A comprehensive literature search was carried out using several databases. The random effect model using inverse variance method and DerSimonian and Laird estimator of Tua2 was used to calculate the pooled prevalence and associated 95% confidence interval (CI). Results for outcome analysis were presented as odds ratios (ORs) with 95% CI and pooled using the Mantel-Haenszel random-effects model. The pooled prevalence of NOAF in COVID-19 was 7.8% (95% CI: 6.54%-9.32%),a pooled estimate from 30 articles (81 929 COVID-19 patients). Furthermore, our analysis reported that COVID-19 patients with NOAF had a higher risk of developing severe disease compared with COVID-19 patients without a history of atrial fibrillation (OR = 4.78, 95% CI: 3.75-6.09) and COVID-19 patients with a history of pre-existing atrial fibrillation (OR = 2.75, 95% CI: 2.10-3.59). Similarly, our analysis also indicated that COVID-19 patients with NOAF had a higher risk of all-cause mortality compared with, COVID-19 patients without a history of atrial fibrillation (OR = 3.83, 95% CI: 2.99-4.92) and COVID-19 patients with a history of pre-existing atrial fibrillation (OR = 2.32, 95% CI: 1.35-3.96). The meta-analysis did not reveal any significant publication bias. The results indicate a strong correlation between NOAF and a higher risk of severe illness and mortality. These results emphasize the importance of careful surveillance, early detection, and customized NOAF management strategies to improve clinical outcomes for COVID-19 patients.
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Affiliation(s)
- Sawai Singh Rathore
- Department of Internal Medicine, Dr. Sampurnanand Medical College, Jodhpur, Rajasthan, India
| | - Akanksha Atulkar
- Department of Internal Medicine, Global Remote Research Scholars Program, St. Paul, Minnesota, USA
| | - Kavya Remala
- Department of Internal Medicine, Konaseema Institute of Medical Sciences, Amalapuram, Andhra Pradesh, India
| | | | - Ameer Mustafa Farrukh
- Department of Internal Medicine, University of Galway School of Medicine, Galway, Ireland
| | - Ravinderjeet Kaur Puar
- Department of Internal Medicine, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Sem Josue Nsanh Yao
- Department of Internal Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | | | - Nirmal Patel
- Department of Internal Medicine, St. George's University School of Medicine, True Blue, Grenada
| | - Naganath Thota
- Department of Internal Medicine, Baptist Memorial Hospital, Memphis, Tennessee, USA
| | - Ashish Kumar
- Department of Internal Medicine, Cleveland Clinic Akron General, Akron, Ohio, USA
| | - Abhishek Deshmukh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Vinci A, Furia G, Cammalleri V, Colamesta V, Chierchini P, Corrado O, Mammarella A, Ingravalle F, Bardhi D, Malerba RM, Carnevale E, Gentili S, Damiani G, De Vito C, Maurici M. Burden of delayed discharge on acute hospital medical wards: A retrospective ecological study in Rome, Italy. PLoS One 2024; 19:e0294785. [PMID: 38265995 PMCID: PMC10807762 DOI: 10.1371/journal.pone.0294785] [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] [Received: 07/05/2023] [Accepted: 11/09/2023] [Indexed: 01/26/2024] Open
Abstract
INTRODUCTION Delayed discharge represents the difficulty in proceeding with discharge of patients who do not have any further benefit from prolonged stay. A quota of this problem is related to organizational issues. In the Lazio region in Italy, a macro service re-organization in on the way, with a network of hospital and territorial centers engaged in structuring in- and out- of hospital patient pathways, with a special focus on intermediate care structures. Purpose of this study is to quantify the burden of delayed discharge on a single hospital structure, in order to estimate costs and occurrence of potential resource misplacement. MATERIAL AND METHODS Observational Retrospective study conducted at the Santo Spirito Hospital in Rome, Italy. Observation period ranged from 1/09/2022, when the local database was instituted, to 1/03/2023 (6 months). Data from admissions records was anonymously collected. Data linkage with administrative local hospital database was performed in order to identify the date a discharge request was fired for each admission. Surgical discharges and Intensive Care Unit (ICU) discharges were excluded from this study. A Poisson hierarchical regression model was employed to investigate for the role of ward, Severity of Disease (SoD) and Risk of Mortality (RoM) on elongation of discharge time. RESULTS 1222 medical ward admissions were recorded in the timeframe. 16% of them were considered as subject to potentially elongated stay, and a mean Delay in discharge of 6.3 days (SD 7.9) was observed. DISCUSSION AND CONCLUSIONS Delayed discharge may cause a "bottleneck" in admissions and result in overcrowded Emergency Department, overall poor performance, and increase in overall costs. A consisted proportion of available beds can get inappropriately occupied, and this inflates both direct and indirect costs. Clinical conditions on admission are not a good predictor of delay in discharge, and the root causes of this phenomenon likely lie in organizational issues (on structure\system level) and social issues (on patient's level).
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Affiliation(s)
- Antonio Vinci
- Hospital Health Management Area, Local Health Authority “ASL Roma 1”, Rome, Italy
- Doctoral School of Nursing Sciences and Public Health, University of Rome “Tor Vergata”, Rome, Italy
| | - Giuseppe Furia
- Hospital Health Management Area, Local Health Authority “ASL Roma 1”, Rome, Italy
- Department of Public Health and Infectious Disease, Sapienza University of Rome, Rome, Italy
| | - Vittoria Cammalleri
- Department of Public Health and Infectious Disease, Sapienza University of Rome, Rome, Italy
| | - Vittoria Colamesta
- Hospital Health Management Area, Local Health Authority “ASL Roma 1”, Rome, Italy
| | - Patrizia Chierchini
- Hospital Health Management Area, Local Health Authority “ASL Roma 1”, Rome, Italy
| | - Ornella Corrado
- Hospital Health Management Area, Local Health Authority “ASL Roma 1”, Rome, Italy
| | - Assunta Mammarella
- Hospital Health Management Area, Local Health Authority “ASL Roma 1”, Rome, Italy
| | - Fabio Ingravalle
- Doctoral School of Nursing Sciences and Public Health, University of Rome “Tor Vergata”, Rome, Italy
- Hospital Health Management Area, Local Health Authority “ASL Roma 6”, Albano Laziale, Italy
| | - Dorian Bardhi
- Post-Graduate School of Hygiene and Preventive Medicine, University of L’Aquila, L’Aquila, Italy
| | - Rosa Maria Malerba
- School of Specialization in Hygiene and Public Health, University of Rome “Tor Vergata”, Rome, Italy
| | - Edoardo Carnevale
- School of Specialization in Hygiene and Public Health, University of Rome “Tor Vergata”, Rome, Italy
| | - Susanna Gentili
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Gianfranco Damiani
- Department of Health Sciences and Public Health, Section of Hygiene, Catholic University of the Sacred Heart, Rome, Italy
| | - Corrado De Vito
- Department of Public Health and Infectious Disease, Sapienza University of Rome, Rome, Italy
| | - Massimo Maurici
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, Rome, Italy
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Schiavone M, Gasperetti A, Filtz A, Vantaggiato G, Gobbi C, Tondo C, Forleo GB. Safety and Efficacy of Uninterrupted Oral Anticoagulation in Patients Undergoing Catheter Ablation for Atrial Fibrillation with Different Techniques. J Clin Med 2023; 12:6533. [PMID: 37892671 PMCID: PMC10607349 DOI: 10.3390/jcm12206533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 09/30/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND The safety and efficacy of an uninterrupted direct anticoagulation (DOAC) strategy during catheter ablation (CA) for atrial fibrillation (AF) has not been fully investigated with different ablation techniques. METHODS We evaluated consecutive AF patients undergoing catheter ablation with three different techniques. All patients were managed with an uninterrupted DOAC strategy. The primary endpoint was the rate of periprocedural thromboembolic and bleeding events. The secondary endpoints of the study were the rate of MACE and bleeding events at one-year follow-up. RESULTS In total, 162 patients were enrolled. Overall, 53 were female and the median age was 60 [55.5-69.5] years. The median CHA2DS2-VASc and HAS-BLED scores were 2 [1-4] and 2 [1-2], respectively. In total, 16 patients had a past stroke or TIA while 11 had a predisposition or a history of bleeding. The CA procedure was performed with different techniques: RF 43%, cryoballoon 37%, or laser-balloon 20%. Overall, 35.8% were on rivaroxaban, 20.4% were on edoxaban, 6.8% were on apixaban, and 3.7% were on dabigatran. All other patients were all naïve to DOACs; the first anticoagulant dose was given before the ablation procedure. As for periprocedural complications, we found three groin hematomas not requiring interventions, one ischemic stroke, and one systemic air embolism (the last two likely due to several catheter changes through the transeptal sheath). Five patients reached the secondary endpoints: one patient for a myocardial infarction while four patients experienced minor bleeding during 1-year follow-up. CONCLUSIONS Our results corroborate the safety and the efficacy of uninterrupted DOAC strategy in patients undergoing CA for AF, regardless of the ablation technique.
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Affiliation(s)
- Marco Schiavone
- Cardiology Unit, Luigi Sacco University Hospital, 20131 Milan, Italy; (A.F.); (G.V.); (G.B.F.)
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy;
- Department of System Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Alessio Gasperetti
- Cardiology Unit, Luigi Sacco University Hospital, 20131 Milan, Italy; (A.F.); (G.V.); (G.B.F.)
- Department of System Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
- Department of Cardiology, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Annalisa Filtz
- Cardiology Unit, Luigi Sacco University Hospital, 20131 Milan, Italy; (A.F.); (G.V.); (G.B.F.)
| | - Gaia Vantaggiato
- Cardiology Unit, Luigi Sacco University Hospital, 20131 Milan, Italy; (A.F.); (G.V.); (G.B.F.)
| | - Cecilia Gobbi
- Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20154 Milan, Italy;
| | - Claudio Tondo
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy;
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy
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Lim KR, Lee S, Kim BS, Chun KJ. Long-Term Clinical Implications of Atrial Fibrillation on Mortality in Patients Hospitalized with COVID-19: A Nationwide Cohort Study. J Clin Med 2023; 12:6504. [PMID: 37892642 PMCID: PMC10607130 DOI: 10.3390/jcm12206504] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/27/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Atrial fibrillation (AF) increases the risk of long-term mortality in patients hospitalized with Coronavirus Disease 2019 (COVID-19), but the evidence is limited. METHODS This study used data from the Common Data Model of the Health Insurance Review and Assessment Service of Korea collected between 1 January 2020 and 30 April 2022. A total of 107,247 patients hospitalized with COVID-19 were included in this study. They were divided into two groups according to a history of AF. The primary outcome was all-cause mortality. RESULTS After propensity score stratification, 1919 patients with a history of AF and 105,328 patients without a history of AF who were hospitalized with COVID-19 were analyzed to determine long-term mortality. The primary outcome occurred in 99 of 1919 patients (5.2%) with a history of AF and in 1397 of 105,328 patients (1.3%) without a history of AF (hazard ratio, 1.49; 95% confidence interval 1.20-1.82; p < 0.01). A history of AF was also associated with an increased risk of within 30-day mortality. CONCLUSION A history of AF was associated with an increased risk of long-term mortality in patients hospitalized with COVID-19. Our findings indicate the necessity for physicians to reevaluate the optimal management of patients with AF following discharge.
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Affiliation(s)
- Kyoung Ree Lim
- Division of Infectious Disease, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Seoul 05278, Republic of Korea
| | - Seunghwa Lee
- Division of Cardiology, Department of Medicine, Wiltse Memorial Hospital, Suwon 16480, Republic of Korea
| | - Bum Sung Kim
- Division of Cardiology, Department of Medicine, Konkuk University Medical Center, 120-1 Neungdong-ro, Seoul 05030, Republic of Korea
| | - Kwang Jin Chun
- Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, 156, Baekryung-ro, Chuncheon 24289, Republic of Korea
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Cerezo Manchado JJ, Iturbe Hernández T, Martínez Pacheco MDC, Gil Ortega I, Campoy D, Canals Pernas T, Martinez Serra L, Flores Aparco KJ, Velasquez Escandon CA, García de Guadiana-Romualdo L, Martinez Frances A, Olivera P. Impact of New Onset Atrial Fibrillation in Hospitalized Patients with COVID-19. Results of the "ACO-VID" Registry. Clin Appl Thromb Hemost 2023; 29:10760296231208440. [PMID: 37899606 PMCID: PMC10617267 DOI: 10.1177/10760296231208440] [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: 06/28/2023] [Revised: 09/12/2023] [Accepted: 10/02/2023] [Indexed: 10/31/2023] Open
Abstract
OBJECTIVE To assess the impact of new-onset atrial fibrillation (AF) on patients hospitalized with coronavirus disease 2019 (COVID-19). METHODS Multicenter and retrospective study that included subjects >55 years hospitalized with COVID-19 from March to October 2020 in Spanish hospitals. Patients were divided into 3 groups (no AF, new-onset AF, and preexisting AF) and followed-up to 90 days. RESULTS A total of 668 patients were included, of whom 162 (24.3%) had no AF, 107 (16.0%) new-onset AF and 399 (59.7%) preexisting AF. Compared to patients without AF, those patients with new-onset AF were older and had more comorbidities, but without differences with preexisting AF. During hospitalization, in the univariate analysis, compared to patients without AF, major bleeding and cardiovascular mortality were more frequent in patients with new-onset AF (10.3% vs 0.6%; P < .001; 2.8% vs 0.6%; P = .025, respectively), with a trend toward more stroke (1.9% vs 0%; P = .085). Outcomes were similar between AF groups, but the length of stay was greater in preexisting AF patients. Among patients with new-onset AF taking reduced doses of anticoagulant treatment was associated with higher risks of stroke and major bleeding. CONCLUSIONS In COVID-19 hospitalized patients, new-onset AF may be associated with worse outcomes, but influenced by the dose of anticoagulants.
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Affiliation(s)
| | | | | | - Ignacio Gil Ortega
- Department of Cardiology, Hospital Clínico Universitario Santa Lucía, Cartagena, Spain
| | - Desirée Campoy
- Thrombosis and Hemostasis Unit, Department of Hematology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Tania Canals Pernas
- Departament of Hematology, Hospital Universitario Sant Joan de Reus, Reus, Spain
| | - Laia Martinez Serra
- Department of Hematology, University Hospital Sant Joan de Reus, Tarragona, Spain
| | | | | | | | | | - Pavel Olivera
- Thrombosis and Hemostasis Unit, Department of Hematology, Vall d'Hebron University Hospital, Barcelona, Spain
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