Pre-existing atrial fibrillation is associated with increased mortality in COVID-19 Patients

Purpose: The impacts of pre-existing atrial fibrillation (AF) on COVID-19-associated outcomes are unclear. We conducted a systematic review and meta-analysis to investigate the pooled prevalence of pre-existing AF and its short-term mortality risk in COVID-19 patients.

Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed in abstracting data and assessing validity. We searched MEDLINE and Scopus to locate all the articles published up to January 31, 2021, reporting data on pre-existing AF among COVID-19 survivors and non-survivors. The pooled prevalence of pre-existing AF was calculated using a random effects model and presenting the related 95% confidence interval (CI), while the mortality risk was estimated using the Mantel-Haenszel random effects models with odds ratio (OR) and related 95% CI. Statistical heterogeneity was measured using the Higgins I² statistic.

Results: Twelve studies, enrolling 15.562 COVID-19 patients (mean age 71.6 years), met the inclusion criteria and were included in the final analysis. The pooled prevalence of pre-existing AF was 11.0% of cases (95% CI: 7.8-15.2%, p < 0.0001) with high heterogeneity (I² = 95.2%). Pre-existing AF was associated with higher risk of short-term death (OR 2.22, 95% CI 1.47-3.36, p < 0.0001), with high heterogeneity (I² = 79.1%).

Conclusion: Pre-existing AF is present in about 11% of COVID-19 cases but results associated with an increased risk of short-term mortality.