New-onset Atrial Fibrillation: An Independent Predictor of in-hospital Mortality in Reduced Ejection Fraction Heart Failure Patients

Year 2020, Volume: 73 Issue: 2, 102 - 106, 31.08.2020

Nil Özyüncü , H.sadi Güleç

Abstract

Objectives: Heart failure (HF) is associated with high mortality and atrial fibrillation (AF) is the most common arrhythmia encountered in HF patients with reduced ejection fraction (EF). We aimed to assess whether new-onset AF is an independent poor prognostic factor in this group of patients. We also searched for parameters that might influence the in-hospital mortality in reduced EF heart failure (HFrEF) patients.

Materials and Methods: The study was a retrospective observational study investigating the admission characteristics and in-hospital events for 119 HFrEF patients at sinus rhytym, admitted for decompensated heart failure. We evaluated the in-hospital mortality and aimed to identify the predictive factors.

Results: Overall 12% of the heart failure patients died during hospitalization. The mean age of the study population was 71±9 years with 37% female. The mean EF was 27±7% and mean duration of hospitalization was 9±4 days. Patients with lower body mass index, lower glomerular filtration rate and patients with longer hospitalization had significantly higher in-hospital mortality rates (p=0.02, p=0.04 and p=0.001, respectively). New-onset AF, restrictive filling pattern and being angiotensin-converting enzyme inhibitors/angiotensin receptor blockers naive were factors significantly related to higher mortality (p=0.001, p=0.001 and p=0.02, respectively). Long hospitalization duration and new-onset AF at hospital were independent predictors of in-hospital mortality [p=0.006 Odds ratio (OR): 1.394 (1.098-1.771) and p=0.012 OR: 10.869 (2.677-71.428), respectively].

Conclusion: In hospital outcome of patients admitted with decompensated HFrEF is poor. In our trial, patients with new-onset AF and patients with longer hospitalization duration had higher mortality rates. An understanding of the risk factors for in-hospital deaths may help improving intensive care for this patient population.

Keywords

New Onset Atrial Fibrillation , Heart Failure Reduced Ejection Fraction , Mortality

Düşük Ejeksiyon Fraksiyonlu Kalp Yetersizliği Hastalarında Hastane İçi Mortaliteyi Artıran Bağımsız Bir Belirteç Olarak Yeni Başlangıçlı Atriyal Fibrilasyon

Abstract

Amaç: Kalp yetersizliği yüksek mortalite ile ilişkili olup, atriyal fibrilasyon (AF) düşük ejeksiyon fraksiyonlu kalp yetersizliği (HFrEF) hastalarında en sık görülen aritmidir. Çalışmamızda, bu hastalarda yeni başlangıçlı AF’nin bağımsız prognostik bir belirteç olup olmadığını araştırdık. Ayrıca, çalışmamızda HFrEF hastalarında hastane içi mortaliteyi etkileyen diğer parametreler de değerlendirildi.

Gereç ve Yöntem: Çalışmamız retrospektif, gözlemsel bir çalışmadır. Dekompanse kalp yetersizliği nedeniyle hastanemize kabul edilen sinüs ritmindeki 119 düşük ejeksiyon fraksiyonlu (EF) hasta yatış özellikleri, hastane içi olaylar ve mortalite açısından değerlendirilmiştir.

Bulgular: Hastaların %12’si hastane izlemi sırasında kaybedilmiştir. Hastaların ortalama yaşı 71±9 olup %37’si kadındır. Ortalama EF’si 27±7 olup ortalama hastanede yatış süresi 9±4 gündü. Düşük vücut kitle indeksi, düşük glomerüler filtrasyon hızı ve uzun hastane yatışı olan hastalar daha fazla hastane içi mortaliteye sahipti (sırasıyla; p=0,02, p=0,04 ve p= 0,001). Yeni başlangıçlı AF, restriktif doluş bozukluğu ve anjiyotensin enzim/ reseptör inhibitörleri kullanmamak da yüksek hastane içi mortalite ile anlamlı olarak ilişkiliydi (sırasıyla; p=0,001, p=0,001 ve p=0,02). Uzun hastane yatışı ve yeni başlangıçlı AF hastane içi mortalite için bağımsız belirleyiciler olarak saptandı [sırasıyla p=0,006 Odds oranı (OR): 1,394 (1,0988-1,771] ve p=0,012 OR: 10,869 (2,677-71,428)].

Sonuç: Hastaneye dekompanse olarak kabul edilen HFrEF hastalarında prognoz kötüdür. Çalışmamızda yeni başlangıçlı AF ve uzamış hastane yatışının mortalite üzerine bağımsız olarak etki eden belirteçler olduğunu saptadık. Hastane içi ölümlere etki eden prognostik belirteçleri iyi saptayabilmek, bu hastalarda daha yoğun ve etkin hedefler için yardımcı olabilir.

Keywords

Yeni Başlangıçlı Atriyal Fibrilasyon , Düşük Ejeksiyon Fraksiyonlu Kalp Yetersizliği , Mortalite

References

• 1. Savelieva I, Camm AJ. Atrial fibrillation and heart failure: natural history and pharmacological treatment. Europace. 2004;5(Suppl 1):S5-S19.
• 2. Aleong RG, Sauer WH, Davis G, et al. New-onset atrial fibrillation predicts heart failure progression. Am J Med. 2014;127:963-971.
• 3. Benjamin EJ, Wolf PA, D’Agostino RB, et al. Impact of atrial fibrillation on the risk of death: the Framingham Heart Study. Circulation. 1998;98:946- 952.
• 4. Anter E, Jessup M, Callans DJ. Atrial fibrillation and heart failure: treatment considerations for a dual epidemic. Circulation. 2009;119:2516-2525.
• 5. Tribouilloy C, Rusinaru D, Leborgne L, et al. In-hospital mortality and prognostic factors in patients admitted for new-onset heart failure with preserved or reduced ejection fraction: a prospective observational study. Arch Cardiovasc Dis. 2008;101:226-234.
• 6. Kirchhof P, Benussi S, Kotecha D, et al. ESC Scientific Document Group. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2016;37:2893-2962.
• 7. McKee PA, Castelli WP, McNamara PM, et al. The natural history of congestive heart failure: the Framingham study. N Engl J Med. 1971;285:1441-1446.
• 8. Ponikowski P, Voors AA, Anker SD, et al. Authors/Task Force Members; Document Reviewers. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail. 2016;18:891-975.
• 9. Ponikowski P, Voors AA, Anker SD, et al. ESC Scientific Document Group. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016;37:2129-2200.
• 10. Mogensen UM, Jhund PS, Abraham WT, et al. PARADIGM-HF and ATMOSPHERE Investigators and Committees. Type of Atrial Fibrillation and Outcomes in Patients With Heart Failure and Reduced Ejection Fraction. J Am Coll Cardiol. 2017;70:2490-2500.
• 11. Pozzoli M, Cioffi G, Traversi E, et al. Predictors of primary atrial fibrillation and concomitant clinical and hemodynamic changes in patients with chronic heart failure: a prospective study in 344 patients with baseline sinus rhythm. J Am Coll Cardiol. 1998;32:197-204.
• 12. Zareba W, Steinberg JS, McNitt S, et al. MADIT II Investigators. Implantable cardioverter-defibrillator therapy and risk of congestive heart failure or death in MADIT II patients with atrial fibrillation. Heart Rhythm. 2006;3:631-637.
• 13. Ziff OJ, Carter PR, McGowan J, et al. The interplay between atrial fibrillation and heart failure on long-term mortality and length of stay: Insights from the, United Kingdom ACALM registry. Int J Cardiol. 2018;252:117-121.
• 14. Fonarow GC, Adams KF Jr, Abraham WT, et al. ADHERE Scientific Advisory Committee, Study Group, and Investigators. Risk stratification for inhospital mortality in acutely decompensated heart failure: classification and regression tree analysis. JAMA. 2005;293:572-580.
• 15. Bloom MW, Greenberg B, Jaarsma T, et al. Heart failure with reduced ejection fraction. Nat Rev Dis Primers. 2017;3:17058.
• 16. Bajraktari G, Miccoli M, Buralli S, et al. Plasma metalloproteinase-9 and restrictive filling pattern as major predictors of outcome in patients with ischemic cardiomyopathy. Eur J Intern Med. 2012;23:616-620.
• 17. Ruddox V, Sandven I, Munkhaugen J, et al. Atrial fibrillation and the risk for myocardial infarction, all-cause mortality and heart failure: A systematic review and meta-analysis. Eur J Prev Cardiol. 2017;24:1555-1566.