Atrial Fibrillation and Documented Heart Failure in Patients Hospitalized with COVID-19: A Secondary Analysis of a Single-Centre Cohort from Western Romania
Aug 2026· Journal of Clinical Medicine· Vol 15· 0 citations· 41 references
Medicine
TL;DR
The findings are best interpreted as evidence of cardiovascular and multimorbidity complexity, not as proof of a COVID-specific, temporal, or causal AF–HF effect.
Abstract
Background/Objectives: Atrial fibrillation (AF) and heart failure (HF) frequently coexist, but later-pandemic data from Eastern Europe are limited. We evaluated their documented coexistence in patients hospitalized with COVID-19; the study was not designed to determine whether SARS-CoV-2 modifies the established AF–HF relationship. Methods: We retrospectively analysed 395 adults admitted with RT-PCR-confirmed SARS-CoV-2 infection between 1 September 2022 and 31 December 2024. AF was identified from the admission record, while HF was determined by an audited, rule-based review of cardiovascular free-text entries. A modified Poisson model with robust variance was the primary analysis and estimated adjusted prevalence ratios (aPRs) after adjustment for age, sex, body mass index, hypertension, ischaemic heart disease, pre-existing type 2 diabetes, chronic kidney disease, chronic obstructive pulmonary disease, smoking, and prior ischaemic stroke. Logistic regression and a restrictive NYHA-coded HF definition were sensitivity analyses. Results: AF was documented in 68 patients (17.2%), HF in 106 (26.8%), and both conditions in 26 (6.6%). HF prevalence was 38.2% among patients with AF and 24.5% among those without AF. AF was associated with documented HF in the primary model (aPR 1.51, 95% confidence interval 1.06–2.16; p = 0.022); age was also associated with HF (aPR 1.02 per year, 95% confidence interval 1.01–1.04; p = 0.010). Results were similar with the restrictive HF definition (aPR 1.54, 95% confidence interval 1.07–2.23) and logistic regression (adjusted odds ratio 1.89, 95% confidence interval 1.06–3.37). Exploratory mortality estimates were imprecise and were not used for prognostic inference. Conclusions: AF identified a subgroup with a higher prevalence of documented HF within this hospitalized COVID-19 cohort. The findings are best interpreted as evidence of cardiovascular and multimorbidity complexity, not as proof of a COVID-specific, temporal, or causal AF–HF effect.
It is suggested that AF remains a risk factor for OHCA, even after adjustments for ischemic heart disease and heart failure, even after adjustments for ischemic heart disease and heart failure.
D. Rajan, T. Skjelbred, P. E. Warming et al.· JACC Clinical Electrophysiol...· 0 citations
Prediabetes was associated with a modestly increased risk of new-onset AF, particularly persistent AF, and was associated with HF development among individuals without established arrhythmia.
K. Ukita, Lotta Nowak, F. Schmelter et al.· Clinical Research in Cardiol...· 0 citations
BackgroundNew-onset atrial fibrillation (AF) is a common complication of sepsis, affecting 5-25% of patients, and is associated with increased mortality and ischemic stroke. With limited high-quality evidence, the net clinical benefit of early oral anticoagulant (OAC) initiation in this high-risk setting remains uncertain.MethodsAdults ≥18 hospitalized with sepsis who developed new-onset AF within 3 days were identified from the TriNetX database. Cohort one included patients who received at least three doses of OAC within 3 days after AF onset and was compared to those who did not receive OAC (cohort two). Propensity score matching (1:1; 90 covariates; caliper 0.1) was employed to balance the groups. The primary outcomes assessed were evaluated at 7, 14, and 30 days. Risk ratios and risk differences with 95% confidence intervals were estimated using intention-to-treat analysis.ResultsAmong 136,172 eligible patients, 10,773 were matched per group. Early OAC use was associated with significantly lower mortality at 7, 14, and 30 days (RR 0.19-0.35; all p < 0.001) and reduced ischemic stroke risk across the same intervals (RR 0.74-0.83; p ≤ 0.004). Major bleeding rates were also lower (RR 0.40-0.49; all p < 0.001). MACEs showed a modest reduction at 7 days (RR 0.92; p = 0.001) but not afterward. Thromboembolic events were similar beyond the first week. The need for thrombolytics (RR 0.55-0.59) and anti-hemorrhagic therapy (RR≈0.69) consistently remained lower with OACs (all p < 0.001). Falsification outcomes were neutral, except for a minimal late increase for osteoarthritis at 30 days (RR 1.16; p = 0.03).ConclusionIn sepsis-associated NOAF, early OAC initiation was associated with reduced short-term mortality and ischemic stroke without excess bleeding or thromboembolic risk. The large magnitude of mortality benefit and paradoxical reduction in bleeding likely reflect residual confounding by clinical stability and patient selection. Findings warrant cautious interpretation given the observational design; prospective trials are needed.
A. Qadeer, Michele Fouad, Doaa Bayomi et al.· Journal of Intensive Care Me...· 0 citations
Atrial fibrillation (Afib) and type 2 DM (T2DM) are common conditions associated with substantial cardiovascular morbidity and mortality. However, data on the burden of Afib among patients with T2DM in sub-Saharan Africa remain limited. This study aimed to determine the prevalence, clinical features, and factors associated with Afib among adults with T2DM at Hoima Regional Referral Hospital (HRRH), western Uganda. A hospital-based cross-sectional study was conducted among 355 adults with T2DM attending HRRH. Participants underwent clinical evaluation, glycated hemoglobin (HbA1c) testing, and 12-lead electrocardiography (ECG) for Afib diagnosis. Logistic regression analysis was used to identify factors associated with Afib, with statistical significance set at p < 0.05. The prevalence of Afib was 7.9% (28/355). Patients with Afib commonly presented with palpitations, dizziness, fatigue, chest pain, and dyspnea, with tachycardia and irregular pulse frequently observed on examination. In multivariable analysis, hypertension (aOR 3.027, 95% CI 1.419–6.431; p = 0.020), human immunodeficiency virus (HIV) infection (aOR 2.026, 95% CI 1.738–6.538; p = 0.048), body mass index (BMI ≥ 25 kg/m²) (aOR 3.014, 95% CI 1.242–7.930; p = 0.029), and poor glycemic control (HbA1c ≥ 8%) (aOR 3.813, 95% CI 1.762–8.265; p = 0.007) were independently associated with Afib. Afib is relatively common among adults with T2DM in western Uganda, affecting nearly one in ten patients. Hypertension, HIV infection, obesity, and poor glycemic control were significant associated factors. Integrating ECG screening into diabetes care, particularly for high-risk patients may improve early detection and management in resource-limited settings.
Abdisamad Guled Hersi, Abdisalam Ahmed Sandeyl, Farah Dubad Abdi et al.· Cardiovascular Diabetology· 0 citations
A supervised machine learning algorithm for AF in a Western Pacific population was derived and demonstrated that higher risk was associated with hospitalisation for other cardio-renal diseases and death.
J. Hsu, C. Hayward, Tobin Joseph et al.· Heart, Lung and Circulation· 0 citations
The occurrence of NOAF was associated with increased in-hospital mortality, which was 2–3 times higher in patients with arrhythmia, and most NOAF prediction models developed specifically in STEMI cohorts undergoing PCI demonstrated higher discriminative ability.
R. L. Pak, B. I. Geltser, E. Kokarev et al.· Siberian Journal of Clinical...· 0 citations