Abstract 14869: Effects of Atrial Fibrillation on Hospitalizations and Survival in Patients Hospitalized for Systolic Heart Failure: Insights from the ESCAPE Trial.
Background: Atrial fibrillation (AF) is associated with worse outcomes in patients (pts) with chronic heart failure (HF). The effects of AF on outcomes in pts hospitalized for systolic HF have not been reported.
Methods: Using log-rank test and Cox proportional hazards, we analyzed the ESCAPE trial (n=433) to determine the effects of baseline AF on rehospitalizations and survival in the first 6 months post discharge.
Results: AF was present in 32% of pts. AF pts were older (62 ± 12 yrs vs. 54 ± 14 yrs), more likely to be white (70% vs. 55%), and have an ischemic etiology (60% vs. 45%). AF pts had similar HR (82 ± 15 bpm), EF (0.20 ± 0.10) and LVEDD (65 ± 10 mm vs. 67 ± 11 mm, p = 0.12), but increased LA size (55 ± 7 mm vs.50 ± 7 mm, p < 0.001) and mitral regurgitation (MR) (MR color area 11.5 ± 7 cm2 vs. 8.8 ± 6 cm2, p = 0.003), compared to non-AF pts. Eighty three (19%) pts died in the first 6 months post discharge. In univariate analyses, AF pts had an increased risk for all-cause (HR 1.58, 95% CI 1.02–2.45, p = 0.04) and cardiovascular death (HR 1.63, 95% CI 1.00–2.66, p = 0.05). In multivariable analyses these effects were no longer significant: HR for all cause-mortality was 1.34 with 95% CI 0.86–2.11 (p = 0.20). Pts with AF were more likely to be rehospitalized within 6 months of discharge (HR 1.55, 95% CI 1.19–2.01, p < 0.001) (Figure 1). This was driven mainly by rehospitalizations for HF (HR 1.58, 95% CI 1.18–2.11, p = 0.002), with less effect on rehospitalizations for arrhythmias (HR 1.44, 95% CI 0.75–2.75, p > 0.2). Multivariable analyses revealed an interaction between AF and age on rehospitalizations (p = 0.003). AF increased the risk of hospitalizations only in older patients: HR in pts over 70 yrs of age was 2.14, with 95% CI 1.50–3.05, p < 0.01.
Conclusions: The impact of AF to predict higher post discharge mortality in pts admitted with systolic HF is largely explained by association with other adverse prognostic indicators. However, AF appears to independently increase the risk of rehospitalizations in older pts.
- © 2010 by American Heart Association, Inc.