Presence of Atrial Fibrillation Is Independently Associated With Adverse Outcomes in Patients Hospitalized With Heart Failure: An Analysis of GWTG-Heart Failure

Feb 27, 2012
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Authors:
Mountantonakis SE, Grau-Sepulveda MV, Bhatt DL, Hernandez AF, Peterson ED, Fonarow GC.
Citation:
Circ Heart Fail 2012;Feb 23:[Epub ahead of print].
Summary By:
Fred Morady, MD, FACC

Study Questions:

How does atrial fibrillation (AF) affect in-hospital outcomes in patients with heart failure (HF)?

Methods:

This was an analysis of hospital outcomes in 99,810 patients (mean age 74 years) enrolled in the Get With The Guidelines HF registry, and hospitalized for new or worsening HF.

Results:

AF was present in 31.4% of patients. The AF was newly diagnosed in 6.7% of patients. The mean hospital length of stay was significantly longer in patients with AF (5 days) than in patients without AF (4 days), as was hospital mortality (4% vs. 2.6%, respectively). Patients with AF were more often discharged to a facility other than home than were patients without AF (28.5% vs. 19.7%, respectively). AF was independently associated with hospital mortality (odds ratio [OR], 1.17). The association with mortality was stronger for newly diagnosed AF (OR, 1.29).

Conclusions:

The authors concluded that AF present at the time of hospitalization is independently associated with adverse hospital outcomes in patients with HF.

Perspective:

An important question that remains unanswered is whether AF is the direct cause of adverse hospital outcomes in patients with AF or whether it is simply a marker of more severe HF or comorbidities. If the former were the case, this would provide strong support for a rhythm-control strategy over a rate-control strategy in patients with HF and AF.

Keywords: Odds Ratio, Hospital Mortality, Biomarkers, Heart Failure, Comorbidity, Hospitalization


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