COVID-19 risks: Irregular heartbeat may increase risk, blood pressure medicines do not

Embargoed until 4 a.m. CT/5 a.m. ET, Monday, Nov. 9, 2020

DALLAS, Nov. 9, 2020 — As the COVID-19 pandemic continues to affect people around the globe, research is ongoing to facilitate a greater understanding of the virus to improve patient care and outcomes. Heart health and medications and the potential role each have on patients with COVID-19 have been the focus of hundreds of studies. The American Heart Association will host experts presenting the latest COVID-19 research at its Scientific Sessions 2020; two studies are highlighted below. The meeting will be held virtually, Friday, November 13 – Tuesday, November 17, 2020, and is a premier global exchange of the latest scientific advancements, research and evidence-based clinical practice updates in cardiovascular science for health care worldwide.

Prevalence and Outcomes Among Hospitalized Patients With Covid-19 and Atrial Fibrillation or Flutter (Presentation P2355)

Previous studies have shown higher death rates in COVID-19 patients with evidence of heart damage. Heart damage can manifest as abnormal heart rhythms such as atrial fibrillation and atrial flutter. Atrial fibrillation is the most common form of heart arrhythmias and is an independent risk factor for death, especially in critically ill patients.

This study reviewed the prevalence and outcomes of hospitalized COVID-19 patients with atrial fibrillation and atrial flutter. Researchers reviewed medical records of 435* patients  in the Yale Cardiovascular COVID Registry, who were adults, ages 18 and older (mean age 68.2 years; >50% were male) hospitalized between March and June 2020 in the Yale New Haven Health System. *Please note: This news release includes updated data compared to the abstract.

The data for the first 435 patients included in the registry revealed that 7.8% patients were diagnosed with atrial fibrillation/flutter for the first time in their lives, and 15.9% of the patients had a prior history of these types of arrhythmia. Overall, about one fifth of the patients had an episode of atrial fibrillation/flutter during hospitalization.  

Additional analysis on the outcomes of the patients with atrial fibrillation/flutter showed that patients with a prior history of atrial fibrillation/flutter had a significantly higher risk of death or ICU mortality, independent of other health issues related to the heart, kidneys and lungs. Data also indicated in-hospital atrial arrhythmias were significantly associated with even higher risk of death and ICU mortality, as well as multi-organ failure, such as respiratory failure and renal failure.

“Our study suggests that the combination of COVID-19 and atrial arrhythmias may create a pathologic synergy that markedly increases the risk for major adverse cardiac events and death,” said Zaniar Ghazizadeh, M.D., a lead author of the study and an internal medicine resident at Yale New Haven Hospital/Yale School of Medicine in New Haven, Connecticut.  “COVID-19 places patients at a high risk for abnormal heart rhythms that are, in turn, associated with markedly worse outcomes including death and multi-organ failure. Patients and physicians need to monitor for these arrhythmias closely and treatments needs to be timely.”

The researchers also cite the need for more investigation to understand the mechanisms of heart injury from COVID-19 infection and methods to prevent this complication.

Authors are Zaniar Ghazizadeh, M.D.; Chad Gier, M.D.; Avinainder Singh, M.D., M.M.Sc.; Lina Vadlamani, M.S., M.B.A.; Maxwell Eder, M.D.; Justin Pacor, M.D.; Jakob Park, M.D.; Manan Pareek, M.D., Ph.D.; Zain Ahmed, M.D., M.P.H., M.S.; Kim G. Smolderen, Ph.D.; Judith Lynne Meadows, M.D., M.P.H.; Tariq Ahmad, M.D., M.P.H.; Nihar R. Desai, M.D., M.P.H.; Rachel .J Lampert, M.D.; and James V. Freeman, M.D., M.P.H. The authors’ disclosures are detailed in the abstract. No external funding sources were noted for this study.

Note: Session: EA.APS.25 - Atrial Fibrillation: Screening, Risk Factors, & Ablation Techniques and Outcomes

Meta-analyses for the Effect of Renin-angiotensin-aldosterone System Inhibitors on Mortality and Testing Positive of Covid-19 (Presentation 399)

There has been speculation that two types of medications used to treat high blood pressure and heart failure – angiotensin-converting enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs) – may increase the risk of contracting COVID-19 .

The researchers examined MEDLINE and EMBASE databases for studies that detailed patients treated with ACE inhibitors and/or ARB medications. They conducted two meta-analyses to evaluate the results of 17 trials: 1) to investigate the rate of COVID-19 positive cases, and 2) to determine the death rate among those hospitalized with COVID-19.   

Their analyses yielded these findings:

  • Patients taking ACE inhibitors or ARBs did not have an increased rate of COVID-19 infection; and
  • Hospitalized COVID-19 patients taking ACE inhibitors or ARBs did not have an increased rate of death.  

A sub-analysis was also done, focused on the studies including patients treated for hypertension. The results indicate taking ACE inhibitors and ARBs was associated with a lower death rate among hospitalized COVID-19 patients with a history of hypertension.

“Our study results confirm that patients already taking ACE inhibitors and ARBs should not discontinue taking them due to COVID-19 infection,” said lead study author Yujiro Yokoyama, M.D., surgeon at St. Luke’s University Health Network’s Easton Hospital in Pennsylvania. “Both medications have proven benefits for heart and kidney disease, and this further confirms previous findings that ACE inhibitors do not pose additional risk with COVID-19.”

Early in the COVID-19 pandemic, the American Heart Association issued a joint statement with the Heart Failure  Society of America and the American College of Cardiology to address the use of ACE inhibitors and ARB medications among patients at risk for developing COVID-19. The recommendations called for the continuation of ACE-i or ARB medications among patients already taking them for indications such as heart failure, hypertension or ischemic heart disease. Cardiovascular disease patients who are diagnosed with COVID-19 should be fully evaluated before adding or removing any treatments, and any changes to their treatment should be based on the latest scientific evidence and shared-decision making with their physician and health care team.

Co-authors of the study are Hisato Takagi, M.D., Ph.D.; Tadao Aikawa, M.D., Ph.D.; and Toshiki Kuno, M.D., Ph.D. The authors’ disclosures are detailed in the abstract. No external funding sources were noted for this study.

Note: Session: CV19.AOS.848 - COVID-19: Risk Scores and Risk Factors for Adverse Outcomes

Additional Resources:

Statements and conclusions of studies that are presented at the American Heart Association’s scientific meetings are solely those of the study authors and do not necessarily reflect the Association’s policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. The Association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and biotech companies, device manufacturers and health insurance providers are available here, and the Association’s overall financial information is available here

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