3.4. Prognostic Implications of Arrhythmia on Clinical Outcome
Overall duration of hospitalization was longer in patients with arrhythmia associated with COVID-19 (Table 3). Univariate analysis showed an increase of hospitalization duration of 11.4 days with the presence of incident arrhythmia (95% CI 6.05–16.7 days; p <0.001). Additionally, patients with arrhythmia were more often admitted to ICU or IMC wards (OR 2.37; 95% CI 1.10–5.09; p = 0.03), and incident arrhythmia was associated with a longer duration of hospitalization on ICU/IMC wards (Table 3). Patients with incident arrhythmia more often received vasopressors for circulatory support and non-invasive ventilation or high-flow oxygen-therapy (Table 3). Importantly, patients with arrhythmia more often presented with severe respiratory failure requiring mechanical ventilation (OR 6.69; 95% CI 2.92–15.35; p < 0.001). Duration of mechanical ventilation was not significantly different between patients with and without arrhythmia (Table 3).
With regard to cardiac events, myocardial infarction was more common in the patient group with arrhythmia, however, with a low overall number of events (Table 3). Stroke or transient ischemic attack (TIA) occurred in one case in the patient group with arrhythmia who had a prior diagnosis of AF and frequent PVCs, and in two patients without arrhythmia. All patients with myocardial infarction or stroke/TIA had received anticoagulation therapy with low-molecular-weight-heparin, however, in one patient heparin-therapy was paused after coronary angiography due to severe bleeding complications. In-hospital mortality was significantly elevated in COVID-19 patients with incident arrhythmia during hospitalization (OR 3.02; 95% CI 1.22–7.46; p = 0.02). Multiple regression analyses adjusting for differences in baseline parameters revealed that the incidence of arrhythmia constitutes a more powerful prognostic factor regarding hospitalization duration and the need for mechanical ventilation than age and prevalence of cardiovascular disease (Table 4). Finally, previous diagnosis of cardiovascular disease in our cohort was significantly associated with mortality in these analyses.