COVID-19 and Atrial Fibrillation in Older Patients: Does Oral Anticoagulant Therapy Provide a Survival Benefit?—An Insight from the GeroCovid Registry

Author:

Fumagalli Stefano1ORCID,Trevisan Caterina2,Del Signore Susanna3,Pelagalli Giulia1,Volpato Stefano4,Gareri Pietro5,Mossello Enrico1,Malara Alba6,Monzani Fabio7,Coin Alessandra2,Bellelli Giuseppe8,Zia Gianluca3,Antonelli Incalzi Raffaele9,

Affiliation:

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

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.

Publisher

Georg Thieme Verlag KG

Subject

Hematology

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3