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COVID-19: another reason for anticoagulation in patients with atrial fibrillation
  1. Pekka Raatikainen1,
  2. Riitta Lassila2
  1. 1 Department of Cardiology, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
  2. 2 Coagulation Disorders Unit, Department of Haematology, Comprehensive Cancer Center, Helsinki University Hospital, and Reserach Program Unit of Systems Oncology, University of Helsinki, Helsinki, Finland, Helsinki, Finland
  1. Correspondence to Dr Pekka Raatikainen, Department of Cardiology, Heart and Lung Center, Helsinki University Hospital, Helsinki 00029, Finland; pekka.raatikainen{at}

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Since the outbreak of the pandemic until early 2022, SARS-CoV-2 infection (COVID-19) has affected more than 410 million individuals worldwide, and of those almost 5.9 million people have died. COVID-19 mortality is strongly associated with advanced age, comorbidities, thromboembolism and vaccination status ( Atrial fibrillation (AF) is the most common sustained arrhythmia. Globally, more than 37 million patients have AF, and its prevalence is forecasted to increase more than twofold by 2060.1 Mortality in patients with AF is closely related to the same comorbidities as in COVID-19 including congestive heart failure (CHF) and thromboembolic complications. The risk of AF is elevated among patients with COVID-19, and vice versa.2

In the study published in this issue of Heart, Handy et al evaluated antithrombotic use and the impact of various antithrombotic agents on the outcomes of patients with AF and COVID-19.3 Using routinely updated, linked population-scale electronic health records for 56 million people in England, they found 972 971 individuals with AF and CHA2DS2-VASc score ≥2. Due to the massive sample size, it was possible to control for a wide range of confounding variables without losing statistical power.

AF and COVID-19: a potentially lethal combination

AF and COVID-19 are a common and potentially lethal combination. AF is independently associated with a 1.5-fold to 2-fold increase in all-cause death,1 and although most people with coronavirus infection will develop mild to moderate illness, COVID-19 has been associated with excess mortality. That is, during the pandemic, the number of deaths has been above and beyond what we would have expected under normal conditions ( In a scenario where someone has both AF and COVID-19, the prognosis is even worse. Handy et al reported that 3.8% of patients with AF had COVID-19-related hospitalisation and 2.2% of them died. Concurrent AF has been associated with a fourfold increased risk …

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  • Contributors Both authors have been involved in writing the editorial and approved it.

  • Funding This study was funded by Finnish Foundation for Cardiovascular Research.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Commissioned; internally peer reviewed.

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