Abstract 17207: Characteristics, Management, and Outcomes of Comorbid Atrial Fibrillation in Heart Failure
Introduction: Atrial fibrillation (AF) and heart failure often co-occur, and represent a phenotype at high risk for poor outcomes. However, differences in the characteristics, management, and in-hospital outcomes of AF among those with heart failure with preserved ejection fraction (HFpEF) and those with heart failure with reduced ejection fraction (HFrEF) are not well characterized.
Methods: Using the Nationwide Inpatient Sample, we identified hospitalizations in 2008-2012 for HFpEF with and without AF, and for HFrEF with and without AF based on ICD-9-CM codes. We examined patient characteristics, procedural rates, and in-hospital outcomes. We also examined temporal trends over the study period.
Results: Among those with AF, patients with HFpEF were older and more likely female, had a higher comorbidity burden, and accumulated lower hospital costs compared to those with HFrEF (Table). A low proportion of the cohort underwent either cardioversion (1% in HFpEF; 1% in HFrEF) or catheter ablation (0.1% in HFpEF; 0.2% in HFrEF). Compared to those without AF, those with AF experienced similar length of stay and lower hospital costs regardless of heart failure subtype (Table). In multivariate regression analysis, AF was only associated with in-hospital mortality in HFpEF (OR 1.10, CI [1.08 - 1.11]), but not HFrEF (OR 0.93 [0.92 - 0.94], p-for-interaction<0.001). Among those with HFpEF, both cardioversion (OR 0.74 [0.65 - 0.85], p<0.001) and catheter ablation (OR 0.60 [0.40 - 0.90], p=0.01) were inversely associated with mortality. With regard to temporal trends, prevalence, in-hospital mortality, and hospital cost of AF in both HFpEF and HFrEF increased over the study period (all p-for-trend<0.01).
Conclusions: AF was associated with in-hospital mortality in HFpEF, but not HFrEF. Despite low performance rates, cardioversion and catheter ablation were associated with in-hospital survival, suggesting the potential benefit of a rhythm-control strategy in HFpEF.
Author Disclosures: P. Goyal: None. Z.I. Almarzooq: None. U. Krishnan: None. R.V. Swaminathan: None. D.N. Feldman: None. E.M. Horn: None. L.K. Kim: None.
- © 2016 by American Heart Association, Inc.