Are Pre‐Hospitalization ECG Abnormalities Associated With Increased Mortality in COVID‐19 Patients? A Quantitative Systematic Literature Review

• Published in: Annals of noninvasive electrocardiology 2024-11, Vol.29 (6), p.e70016-n/a
• Main Authors: Askey, Danielle, Smith, Ann
• Format: Article
• Language: English
• Subjects: Abnormalities; Arrhythmias, Cardiac - diagnosis; Arrhythmias, Cardiac - mortality; Arrhythmias, Cardiac - physiopathology; Cardiac arrhythmia; Confounding (Statistics); Coronaviruses; COVID-19; COVID-19 - complications; COVID-19 - mortality; COVID-19 - physiopathology; Data collection; Decision making; Drug administration; ECG; EKG; electrocardiogram; Electrocardiography; Electrocardiography - methods; emergency department; Emergency medical care; Emergency medical services; English language; Heart; Hospitalization; Hospitalization - statistics & numerical data; Hospitals; Humans; Hypertrophy; Intensive care; Literature reviews; Male; Medical personnel; Mortality; Mortality risk; Original; Pandemics; Patients; pre‐hospital; Prolongation; Respiratory diseases; SARS-CoV-2; Search strategies; Severe acute respiratory syndrome coronavirus 2; Systematic review; Validity; Ventricle
• ISSN: 1082-720X; 1542-474X; 1542-474X
• DOI: 10.1111/anec.70016

ABSTRACT Background While COVID‐19 is predominantly a respiratory disease, cardiovascular complications occur and are associated with worse outcomes. Electrocardiogram (ECG) abnormalities are frequently observed in hospitalized COVID‐19 patients, some of which are associated with increased mortality. It is unclear whether ECG abnormalities occurring before hospitalization are associated with increased mortality. This quantitative systematic literature review aims to determine which ECG changes occurring before hospitalization are associated with mortality and discuss whether these findings can aid the assessment of patients and decision‐making in the pre‐hospital environment. Methods A systematic search of the following digital databases was conducted: CINAL, PUBMED, MEDLINE, and Coronavirus Research Database. Eight cohort studies (primary papers) including COVID‐19 patients with ECGs taken in the Emergency Department before hospitalization were selected for quantitative synthesis and results were obtained for the prevalence of ECG changes among survivors compared with non‐survivors. Odds and hazard ratios for ECG abnormalities associated with mortality were also collected and compared. Results Identification of ECG abnormalities on pre‐hospitalization ECG is associated with increased mortality in COVID‐19 patients. These ECG abnormalities include non‐sinus rhythm, QTc prolongation, left bundle branch block, axis deviation, atrial fibrillation, atrial flutter, right ventricular strain patterns, ST segment changes, T wave abnormalities, and evidence of left ventricular hypertrophy. Conclusion Electrocardiogram assessment in the pre‐hospital environment may be beneficial when assessing COVID‐19 patients and could help identify patients at increased risk of mortality. Forest Plot displaying statisticallysignificant adjusted odds ratios (aORs) with 95% confidence levels (CIs) forassociation between emergency department electrocardiogram (ECG) findings andmortality. There appears to be an association between some ECG abnormalitiesand mortality in COVID‐19 patients with CIs overlapping, especially in theright ventricular strain pattern where three studies found a statisticallysignificant aOR associated with mortality with CIs overlapping.