31 SEX- AND AGE SPECIFIC ASSOCIATION OF AF WITH MORTALITY IN COVID-19 INTRODUCTION Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) has infected more than 400 million people worldwide, including more than 160 million Europeans, with almost 5.8 million deaths attributed globally to the virus as of February 11th, 2022.1 With multiple vaccines available as well as the recent increase in immunisation from the omicron variant, which is possibly associated with an overall lower risk of clinical deterioration, some are optimistic that the end of the coronavirus disease 2019 (COVID-19) pandemic is in sight and that SARS-CoV-2 will become a yearly recurring more endemic virus. However, subsequent waves of new infections with new variants are to be expected in the upcoming years, given the 1) low global vaccination rate of 36%,2 and global shortage of vaccines, 2) high threshold needed for herd immunity,3 3) uncertainties regarding the duration of the immunological effect of the vaccines,4 4) high number of intermediate hosts for SARS-CoV-2,5 and in part due to this, 5) the continuous threat of (more contagious) variants reducing vaccine efficacy.6 Therefore, research into COVID-19 remains crucial. Since the start of the pandemic, cardiovascular complications have been increasingly recognised in patients suffering from COVID-19, ranging from vascular damage and cardiac injury to arrhythmias.7 Arrhythmias in COVID-19 patients may impact significantly on disease progression and outcome. As such, various population-based studies have reported a positive association between atrial fibrillation (AF)/atrial flutter (AFL) and mortality.8–10 However, these studies did not look at sex-specific influences, nor at the incremental effect of age (on a continuous scale), despite the fact that these parameters are known to influence AF/AFL outcomes in the general population.11,12 Therefore, in the large international CAPACITY-COVID dataset (NCT04325412) of 5,782 hospitalised COVID-19 patients, using the latest methodology, we explored the relation of AF and AFL to in-hospital mortality, with specific attention for sex- and age-related differences. METHODS Study design and study population For the current multicentre cohort study, pseudo-anonymous data generated during routine clinical care retrieved from the international patient registry CAPACITY-COVID (www.capacity-covid.eu) were used.13 The data within CAPACITY-COVID have been collected by 72 hospitals in 8 European (Belgium, France, Italy, the Netherlands, Portugal, Spain, Switzerland, United Kingdom) and 5 non-European (Egypt, Iran, Israel, Russia, Saudi-Arabia) countries. For this study, patients aged 18 years or older, admitted to any of the participating hospital centres before October 25th, 2020, 3
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