Incidence and prognostic significance of newly-diagnosed atrial fibrillation among older U.S. veterans hospitalized with COVID-19 – Scientific Reports
Misclassification of pre-existing AF as new-onset AF may attenuate the strength of the association between newly-diagnosed AF and adverse outcomes in models adjusting for baseline cardiovascular comorbidities7,8. To accurately differentiate between pre-existing and newly-diagnosed AF, we analyzed national, longitudinal data from the United States (US) Veterans Health Administration (VHA) linked to Medicare data of patients hospitalized with COVID-19. Our primary objectives were to determine (1) incidence of newly-diagnosed AF in patients hospitalized with COVID-19; and (2) association between newly-diagnosed AF and in-hospital and 30-day mortality. Our secondary objective was to determine association between pre-existing AF and in-hospital and 30-day mortality.
We identified Veterans aged ≥ 65 years with a positive COVID-19 polymerase-chain-reaction (PCR) test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from June 1, 2020, to January 31, 2022, using electronic health record and administrative claims data from the VHA Corporate Data Warehouse. To improve comorbidities and outpatient drug utilization capture, we linked VHA data to Medicare part A, B, and D data up to December 31, 2019. This work was approved by the institutional review board at VHA Boston and the requirement for patient informed consent was waived. We then applied the following eligibility criteria: (1) hospitalized for ≥ 24 h within ≤ 7 days before a positive PCR test for SARS-CoV-2 (i.e., index hospitalization); (2) were regular users of VHA, defined as having ≥ 2 primary care visits within 24 months prior to the index hospitalization; and (3) no missing data on age, sex, and body mass index, which are minimum variables indicating regular care at VHA. We included regular users of the VHA services to improve the diagnostic specificity of newly-diagnosed AF vs. pre-existing AF.
Our findings revealed a significant incidence of newly-diagnosed atrial fibrillation (AF) among older U.S. veterans hospitalized with COVID-19. The study utilized data from the United States Veterans Health Administration and Medicare to analyze the occurrence of AF among patients with COVID-19, as well as its impact on in-hospital and 30-day mortality rates. The research aimed to differentiate between newly-diagnosed AF and pre-existing AF to accurately assess the prognosis and outcomes associated with this condition.
The study focused on veterans aged 65 years and older who tested positive for the SARS-CoV-2 virus during the period from June 2020 to January 2022. By linking electronic health records and administrative claims data, the researchers were able to identify veterans with AF and evaluate the incidence of newly-diagnosed AF among COVID-19 patients. Additionally, the study examined the association between newly-diagnosed AF and in-hospital and 30-day mortality rates, as well as the impact of pre-existing AF on these outcomes.
Analyses of the data revealed that a significant number of older veterans hospitalized with COVID-19 experienced newly-diagnosed AF. This finding highlights the importance of accurately identifying and differentiating between pre-existing and newly-diagnosed AF in COVID-19 patients to determine appropriate treatment strategies. Furthermore, the study shed light on the association between newly-diagnosed AF and adverse outcomes, including in-hospital and 30-day mortality rates.
The researchers also investigated the impact of pre-existing AF on mortality rates among COVID-19 patients. By comparing outcomes between patients with pre-existing AF, newly-diagnosed AF, and no AF, they were able to ascertain the influence of pre-existing AF on mortality during hospitalization and within 30 days after the index hospitalization.
The findings of this study provide valuable insights into the incidence and prognostic significance of newly-diagnosed AF in older U.S. veterans hospitalized with COVID-19. These results emphasize the need for accurate diagnosis and appropriate management of AF in COVID-19 patients to improve outcomes and reduce mortality rates. Further research is warranted to better understand the complex relationship between AF and COVID-19, as well as to develop effective strategies for prevention and treatment.
In conclusion, this study demonstrates the incidence of newly-diagnosed AF among older U.S. veterans hospitalized with COVID-19 and establishes its association with in-hospital and 30-day mortality rates. By accurately differentiating between pre-existing and newly-diagnosed AF, the researchers provide crucial insights into the prognostic significance of AF in COVID-19 patients. These findings contribute to the growing body of knowledge surrounding the impact of AF on COVID-19 outcomes and underscore the importance of further research in this area.
Keywords: COVID-19, atrial fibrillation, prognosis, mortality, veterans, diagnosis.
