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Presence of atrial fibrillation is independently associated with adverse outcomes in patients hospitalized with heart failure: an analysis of get with the guidelines-heart failure.
Circ Heart Fail. 2012 Mar 01; 5(2):191-201.CH

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.

Authors+Show Affiliations

North Shore University Hospital and Hofstra School of Medicine, Manhasset, NY 11030, USA. smountanto@nshs.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22361078

Citation

Mountantonakis, Stavros E., et al. "Presence of Atrial Fibrillation Is Independently Associated With Adverse Outcomes in Patients Hospitalized With Heart Failure: an Analysis of Get With the Guidelines-heart Failure." Circulation. Heart Failure, vol. 5, no. 2, 2012, pp. 191-201.
Mountantonakis SE, Grau-Sepulveda MV, Bhatt DL, et al. Presence of atrial fibrillation is independently associated with adverse outcomes in patients hospitalized with heart failure: an analysis of get with the guidelines-heart failure. Circ Heart Fail. 2012;5(2):191-201.
Mountantonakis, S. E., Grau-Sepulveda, M. V., Bhatt, D. L., Hernandez, A. F., Peterson, E. D., & Fonarow, G. C. (2012). Presence of atrial fibrillation is independently associated with adverse outcomes in patients hospitalized with heart failure: an analysis of get with the guidelines-heart failure. Circulation. Heart Failure, 5(2), 191-201. https://doi.org/10.1161/CIRCHEARTFAILURE.111.965681
Mountantonakis SE, et al. Presence of Atrial Fibrillation Is Independently Associated With Adverse Outcomes in Patients Hospitalized With Heart Failure: an Analysis of Get With the Guidelines-heart Failure. Circ Heart Fail. 2012 Mar 1;5(2):191-201. PubMed PMID: 22361078.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Presence of atrial fibrillation is independently associated with adverse outcomes in patients hospitalized with heart failure: an analysis of get with the guidelines-heart failure. AU - Mountantonakis,Stavros E, AU - Grau-Sepulveda,Maria V, AU - Bhatt,Deepak L, AU - Hernandez,Adrian F, AU - Peterson,Eric D, AU - Fonarow,Gregg C, Y1 - 2012/02/23/ PY - 2012/2/25/entrez PY - 2012/3/1/pubmed PY - 2012/5/30/medline SP - 191 EP - 201 JF - Circulation. Heart failure JO - Circ Heart Fail VL - 5 IS - 2 N2 - 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. SN - 1941-3297 UR - https://www.unboundmedicine.com/medline/citation/22361078/Presence_of_atrial_fibrillation_is_independently_associated_with_adverse_outcomes_in_patients_hospitalized_with_heart_failure:_an_analysis_of_get_with_the_guidelines_heart_failure_ L2 - https://www.ahajournals.org/doi/10.1161/CIRCHEARTFAILURE.111.965681?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -