Hospitalization Outcomes in the AHA Get With The Guidelines Atrial Fibrillation and Heart Failure Registries

ABSTRACTBackground Patients hospitalized with atrial fibrillation (AFIB) and heart failure (HF) have high morbidity and mortality rates, yet guideline-directed management of patients hospitalized with AFIB and HF has not been well described. We aimed to characterize patients mutually enrolled into Get With The Guidelines-Atrial Fibrillation (GWTG-AFIB) and -Heart Failure (GWTG-HF) quality registries associated with in-hospital outcomes. Methods and Results Hospitalized patients enrolled in the GWTG-AFIB/GWTG-HF registries were linked by identifiers and mutual encounters. Patients were grouped by those with HF with midrange/preserved ejection fraction (HFmrEF/HFpEF) and reduced ejection fraction (HFrEF). In-hospital mortality rates, lengths of stay, and HF/AFIB quality achievements were summarized. Of 90,531 and 695,889 patient encounters in GWTG-AFIB/GWTG-HF between January 2013 and December 2019, respectively, there were 1,642 hospitalizations among 1,426 uniquely linked patients. Patients with HFmrEF/HFpEF compared with HFrEF were more often older (median age 80 vs 72 years), female (61% vs 33%), and non-Black (95% vs 84%). The lengths of stay were similar in both groups (median, 4 days); patients with HFmrEF/HFpEF compared to those with HFrEF were more likely to remain in AFIB (49% vs 39%), received fewer antiarrhythmics (30% vs 34%) or beta-blockers (75% vs 95%), and underwent fewer cardioversions (12% vs 21%), although in-hospital ablation for AFIB was infrequent in both groups. Conclusions In a contemporary cohort of hospitalized patients uniquely enrolled into both GWTG-AFIB/GWTG-HF quality registries, the use of rhythm-control strategies for atrial fibrillation was uncommon and varied by HF subtype. Implementation efforts may serve to optimize guideline recommendations for AFIB and HF.