Presence of Atrial Fibrillation Is Independently Associated With Adverse Outcomes in Patients Hospitalized With Heart Failure

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–Heart Failure between January 1, 2005, and December 31, 2010. 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 6701 (21.3%) were newly diagnosed. Patients in AF were older (77±12 versus 70±15, P <0.001) and were more likely to have history of stroke and valvular heart disease. AF patients had higher B-type natriuretic peptide levels and ejection fraction (42±17% versus 39±17%, P <0.001). AF patients were more likely to be hospitalized >4 days (48.8% versus 41.5%, P <0.001), discharged to a facility other than home (28.5% versus 19.7%, P <0.001), and had higher hospital mortality rate (4.0% versus 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). Conclusions— In patients hospitalized with HF, AF is present in one-third and is independently associated with adverse hospital outcomes and longer length of stay. Whether prompt restoration of sinus rhythm would improve outcomes in patients hospitalized with HF and new-onset or paroxysmal AF is unclear and requires further study.