Key result
Comorbid AF during HF hospitalizations is linked to ~38% higher in-hospital mortality.
Why the study?
Heart failure and atrial fibrillation frequently coexist and may worsen outcomes, but limited contemporary evidence describes their combined prevalence across HFpEF and HFrEF hospitalizations in the United States.
What are the national trends in the prevalence, outcomes, and costs of atrial fibrillation during hospital admissions for heart failure?
Observational (n=10,392,189)
Yes
What are the national trends in the prevalence, outcomes, and costs of atrial fibrillation during hospital admissions for heart failure?
Atrial fibrillation is increasingly common among heart failure hospitalizations and is associated with higher in-hospital mortality and costs.
Answers are grounded in this paper and cite their sources.
Comorbid AF flags higher mortality risk in HF admissions; leaves open whether targeted interventions improve outcomes.
Background Heart failure (HF) and atrial fibrillation (AF) frequently coexist and may be associated with worse HF outcomes, but there is limited contemporary evidence describing their combined prevalence. We examined current trends in AF among hospitalizations for HF with preserved (HFpEF) ejection fraction or HF with reduced ejection fraction (HFrEF) in the United States, including outcomes and costs. Methods and Results Using the National Inpatient Sample, we identified 10 392 189 hospitalizations for HF between 2008 and 2017, including 4 250 698 with comorbid AF (40.9%). HF hospitalizations with AF involved patients who were older (average age, 76.9 versus 68.8 years) and more likely White individuals (77.8% versus 59.1%; P <0.001 for both). HF with preserved ejection fraction hospitalizations had more comorbid AF than HF with reduced ejection fraction (44.9% versus 40.8%). Over time, the proportion of comorbid AF increased from 35.4% in 2008 to 45.4% in 2017, and patients were younger, more commonly men, and Black or Hispanic individuals. Comorbid hypertension, diabetes mellitus, and vascular disease all increased over time. HF hospitalizations with AF had higher in‐hospital mortality than those without AF (3.6% versus 2.6%); mortality decreased over time for all HF (from 3.6% to 3.4%) but increased for HF with reduced ejection fraction (from 3.0% to 3.7%; P <0.001 for all). Median hospital charges were higher for HF admissions with AF and increased 40% over time (from $22 204 to $31 145; P <0.001). Conclusions AF is increasingly common among hospitalizations for HF and is associated with higher costs and in‐hospital mortality. Over time, patients with HF and AF were younger, less likely to be White individuals, and had more comorbidities; in‐hospital mortality decreased. Future research will need to address unique aspects of changing patient demographics and rising costs.
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Reinhardt et al. (2021) conducted an observational in Heart failure (n=10,392,189). Comorbid atrial fibrillation vs. No atrial fibrillation was evaluated on In-hospital mortality (p=<0.001). Comorbid atrial fibrillation during heart failure hospitalizations was associated with higher in-hospital mortality compared to those without atrial fibrillation.
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