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Thromb Haemost 2022; 122(01): 105-112
DOI: 10.1055/a-1503-3875
Blood Cells, Inflammation and Infection

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

Authors

  • Stefano Fumagalli 

    1   Geriatric Intensive Care Unit and Geriatric Arrhythmia Unit, Department of Experimental and Clinical Medicine, University of Florence and AOU Careggi, Florence, Italy

  • Caterina Trevisan

    2   Geriatrics Division, Department of Medicine (DIMED), University of Padua, Padua, Italy

  • Susanna Del Signore

    3   Bluecompanion ltd, London, United Kingdom

  • Giulia Pelagalli

    1   Geriatric Intensive Care Unit and Geriatric Arrhythmia Unit, Department of Experimental and Clinical Medicine, University of Florence and AOU Careggi, Florence, Italy

  • Stefano Volpato

    4   Section of Internal and Cardiorespiratory Medicine, Department of Medical Science, University of Ferrara, Ferrara, Italy

  • Pietro Gareri

    5   Center for Cognitive Disorders and Dementia - Catanzaro Lido, ASP Catanzaro, Catanzaro, Italy

  • Enrico Mossello

    1   Geriatric Intensive Care Unit and Geriatric Arrhythmia Unit, Department of Experimental and Clinical Medicine, University of Florence and AOU Careggi, Florence, Italy

  • Alba Malara

    6   Scientific Committee of National Association of Third Age Residences (ANASTE) Calabria, Lamezia Terme (Catanzaro), Catanzaro, Italy

  • Fabio Monzani

    7   Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy

  • Alessandra Coin

    2   Geriatrics Division, Department of Medicine (DIMED), University of Padua, Padua, Italy

  • Giuseppe Bellelli

    8   Acute Geriatric Unit, San Gerardo Hospital, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy

  • Gianluca Zia

    3   Bluecompanion ltd, London, United Kingdom

  • Raffaele Antonelli Incalzi

    9   Unit of Geriatrics, Department of Medicine, Campus Bio Medico University and Teaching Hospital, Rome, Italy
    • for the GeroCovid Working Group
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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.

Keywords

atrial fibrillation - COVID-19 - DOACs - aged - oral anticoagulants

* Members of the GeroCovid Working Group are listed in [Supplementary Appendix A] (available in the online version).


Supplementary Material



Publication History

Received: 16 February 2021

Accepted: 05 May 2021

Accepted Manuscript online:
07 May 2021

Article published online:
18 June 2021

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