Stefano Fumagalli1, Caterina Trevisan2, Susanna Del Signore3, Giulia Pelagalli1, Stefano Volpato4, Pietro Gareri5, Enrico Mossello1, Alba Malara6, Fabio Monzani7, Alessandra Coin2, Giuseppe Bellelli8, Gianluca Zia3, Raffaele Antonelli Incalzi9. 1. Geriatric Intensive Care Unit and Geriatric Arrhythmia Unit, Department of Experimental and Clinical Medicine, University of Florence and AOU Careggi, Florence, Italy. 2. Geriatrics Division, Department of Medicine (DIMED), University of Padua, Padua, Italy. 3. Bluecompanion ltd, London, United Kingdom. 4. Section of Internal and Cardiorespiratory Medicine, Department of Medical Science, University of Ferrara, Ferrara, Italy. 5. Center for Cognitive Disorders and Dementia - Catanzaro Lido, ASP Catanzaro, Catanzaro, Italy. 6. Scientific Committee of National Association of Third Age Residences (ANASTE) Calabria, Lamezia Terme (Catanzaro), Catanzaro, Italy. 7. Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy. 8. Acute Geriatric Unit, San Gerardo Hospital, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy. 9. Unit of Geriatrics, Department of Medicine, Campus Bio Medico University and Teaching Hospital, Rome, Italy.
Abstract
INTRODUCTION: Atrial fibrillation (AF), the most frequent arrhythmia of older patients, associates with serious thromboembolic complications and high mortality. Coronavirus disease 2019 (COVID-19) severely affects aged subjects, determining an important prothrombotic status. The aim of this study was to evaluate mortality-related factors in older AF patients with COVID-19. METHODS: Between March and June 2020, we enrolled ≥60 year-old in-hospital COVID-19 patients (n = 806) in GeroCovid, a multicenter observational study promoted by the Italian Society of Gerontology and Geriatric Medicine. RESULTS: The prevalence of AF was 21.8%. In-hospital mortality was higher in the AF group (36.9 vs. 27.5%, p = 0.015). At admission, 51.7, 10.2, and 38.1% of AF cases were taking, respectively, oral anticoagulants (OACs), antiplatelet agents, and no antithrombotic therapy. During hospitalization, 51% patients switched to low-molecular-weight heparins. AF patients who survived were younger (81 ± 8 vs. 84 ± 7 years; p = 0.002) and had a lower CHA2DS2-VASc score (3.9 ± 1.6 vs. 4.4 ± 1.3; p = 0.02) than those who died. OAC use before (63.1 vs. 32.3%; p < 0.001) and during hospitalization (34.0 vs. 12.7%; p = 0.002) was higher among survivors. At multivariable analysis, lower age, higher self-sufficiency, less severe initial COVID-19 presentation, and the use of vitamin K antagonists (odds ratio [OR] = 0.16, 95% confidence interval [CI]: 0.03-0.84) or direct OACs (OR = 0.22, 95% CI: 0.08-0.56) at admission, or the persistence of OAC during hospitalization (OR = 0.05, 95% CI: 0.01-0.24), were associated with a lower chance of in-hospital death. CONCLUSION: AF is a prevalent and severe condition in older COVID-19 patients. Advanced age, dependency, and relevant clinical manifestations of disease characterized a worse prognosis. Preadmission and in-hospital anticoagulant therapies were positively associated with survival. Thieme. All rights reserved.
INTRODUCTION: Atrial fibrillation (AF), the most frequent arrhythmia of older patients, associates with serious thromboembolic complications and high mortality. Coronavirus disease 2019 (COVID-19) severely affects aged subjects, determining an important prothrombotic status. The aim of this study was to evaluate mortality-related factors in older AF patients with COVID-19. METHODS: Between March and June 2020, we enrolled ≥60 year-old in-hospital COVID-19 patients (n = 806) in GeroCovid, a multicenter observational study promoted by the Italian Society of Gerontology and Geriatric Medicine. RESULTS: The prevalence of AF was 21.8%. In-hospital mortality was higher in the AF group (36.9 vs. 27.5%, p = 0.015). At admission, 51.7, 10.2, and 38.1% of AF cases were taking, respectively, oral anticoagulants (OACs), antiplatelet agents, and no antithrombotic therapy. During hospitalization, 51% patients switched to low-molecular-weight heparins. AF patients who survived were younger (81 ± 8 vs. 84 ± 7 years; p = 0.002) and had a lower CHA2DS2-VASc score (3.9 ± 1.6 vs. 4.4 ± 1.3; p = 0.02) than those who died. OAC use before (63.1 vs. 32.3%; p < 0.001) and during hospitalization (34.0 vs. 12.7%; p = 0.002) was higher among survivors. At multivariable analysis, lower age, higher self-sufficiency, less severe initial COVID-19 presentation, and the use of vitamin K antagonists (odds ratio [OR] = 0.16, 95% confidence interval [CI]: 0.03-0.84) or direct OACs (OR = 0.22, 95% CI: 0.08-0.56) at admission, or the persistence of OAC during hospitalization (OR = 0.05, 95% CI: 0.01-0.24), were associated with a lower chance of in-hospital death. CONCLUSION: AF is a prevalent and severe condition in older COVID-19 patients. Advanced age, dependency, and relevant clinical manifestations of disease characterized a worse prognosis. Preadmission and in-hospital anticoagulant therapies were positively associated with survival. Thieme. All rights reserved.
Authors: Alex C Spyropoulos; Jean M Connors; James D Douketis; Mark Goldin; Beverley J Hunt; Taiwo R Kotila; Renato D Lopes; Sam Schulman Journal: J Thromb Haemost Date: 2022-07-29 Impact factor: 16.036
Authors: Marcin Protasiewicz; Konrad Reszka; Wojciech Kosowski; Barbara Adamik; Wojciech Bombala; Adrian Doroszko; Damian Gajecki; Jakub Gawryś; Maciej Guziński; Maria Jedrzejczyk; Krzysztof Kaliszewski; Katarzyna Kilis-Pstrusinska; Bogusława Konopska; Agnieszka Kopec; Krzysztof Kujawa; Anna Langner; Anna Larysz; Weronika Lis; Lilla Pawlik-Sobecka; Joanna Gorka-Dynysiewicz; Marta Rosiek-Biegus; Agnieszka Matera-Witkiewicz; Tomasz Matys; Michał Pomorski; Mateusz Sokolski; Janusz Sokołowski; Anna Tomasiewicz-Zapolska; Katarzyna Madziarska; Ewa A Jankowska Journal: J Clin Med Date: 2022-01-12 Impact factor: 4.241