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

Circheartfailure.ahajournals: Stavros E. Mountantonakis1*, Maria V. Grau-Sepulveda2, Deepak L. Bhatt3, Adrian F. Hernandez2, Eric D. Peterson2 and Gregg C. Fonarow4 -February 23, 2012.

Abstract

Background—It is unclear if the presence of atrial fibrillation (AF) on admission is associated with worse in-hospital outcomes in patients hospitalized with heart failure (HF). This study evaluated the clinical characteristics, management, length of stay, and mortality of HF patients with and without AF.

Methods and Results—We studied 99,810 patients from 255 sites admitted with HF enrolled in Get With The Guidelines HF between 1/1/05 and 12/31/10. Patients with AF on admission were compared with patients in sinus rhythm. A total of 31,355 (31.4%) HF patients presented with AF, of which 6,701 (21.3%) were newly diagnosed. Patients in AF were older (77±12 vs 70±15, P<0.001) and were more likely to have history of stroke and valvular heart disease. AF patients had higher BNP levels and ejection fraction (42±17 vs 39±17%, P<0.001). AF patients were more likely to be hospitalized >4 days (48.8 vs 41.5%, P<0.001), discharged to a facility other than home (28.5 vs 19.7%, P<0.001), and had higher hospital mortality (4.0 vs 2.6%, P<0.001). AF, particularly newly diagnosed, was independently associated with adverse outcomes (adjusted odds ratios and 95% confidence intervals for mortality 1.17, 1.05-1.29, P=0.0029 and 1.29, 1.10-1.52, P=0.0023 for AF and newly diagnosed AF, respectively). Read More