Corticosteroids tied to atrial fibrillation risk in COVID-19 patients: Study
USA: A recent study has reported that corticosteroids, used for treating hypoxic COVID-19 patients, are associated with an increased risk for atrial fibrillation (AF). This indicates that steroids may have a potential direct arrhythmogenic effect in patients with COVID-19.
The study results were presented at the American Heart Association (AHA) Scientific Sessions 2021, held from November 13-15, 2021, and subsequently published in the journal Circulation.
Some studies have suggested an increased AF risk in patients receiving corticosteroids, whereas others have suggested their preventive effect. However, there is a lack of data on the impact of steroids on the incidence of new-onset AF in hospitalized COVID-19 patients. To fill this knowledge gap, Yi Lee, Internal Medicine, St. Joseph Mercy Oakland Hosp, Pontiac, MI, and colleagues conducted a retrospective, multicenter cohort study including patients ≥ 18 years admitted to one tertiary care and five community hospitals for treatment of COVID-19 infection between 3/1/2020 and 3/31/2021.
Based on steroid exposure during hospitalization, subjected were stratified: group 1 (full-dose) received cumulative dosage including dexamethasone ≥ 6 mg/day, methylprednisolone ≥ 80 mg/day or hydrocortisone ≥ 50 mg/day for ≥ 3 days, group 2 (low-dose) did not receive the aforementioned dosage, and group 3 had no steroid usage. Those with a history of AF and length of stay < 3 days were excluded.
Key results of the study include:
- Among 4578 (1556 in group 1, 1046 in group 2, 2156 in group 3) patients (mean age 65.4 ± 61 years, 50.4 % females), 542 patients developed new-onset AF.
- 24.3% of patients in the group 9.3% in group 2, and 8% in group 3 died during hospitalization. In multivariable logistic regression models adjusted for hypoxia and significant baseline demographics (age, sex, body mass index, hypertension, pulmonary disease, chronic kidney disease, liver disease, and cerebrovascular accident), the researchers found that group 1 had a higher incidence of AF compared to group 3 (adjusted relative risk [aRR] 1.59) and group 2 (aRR 1.39).
- The group 2 vs group 3 (aRR 1.14) comparison did not reach statistical significance.
"Corticosteroids, the mainstay of treatment of hypoxic COVID-19 patients, are associated with an increased risk of developing AF," the authors wrote. "This suggests that steroids have a potential direct arrhythmogenic effect in COVID-19 patients."
Reference:
Abstract 13683: Corticosteroids and the Risk of Atrial Fibrillation in Hospitalized COVID-19 Patients, is published in the journal Circulation.
