Patients with atrial fibrillation after discharge from a multidisciplinary hospital: analysis of death risk and its causes based on 10-year follow-up data

Aim. To evaluate the outcomes of 10-year follow-up of patients with atrial fibrillation (AF) after hospitalization in various departments of a multidisciplinary hospital and to determine the most significant prognostic factors associated with a high death risk. Material and methods . In the outpatient registry RECVAZA-AF Tula after discharge from a multidisciplinary hospital, the outcomes for the period 2013-2024 (follow-up, 7,9±3,7 years) were assessed in 1159 patients with AF (age, 69,2±9,8 years; men, 48,0%). Information on fatal outcomes was obtained from the Regional Information System of the Tula Oblast. Results . Over 10 years, 509 (43,9%) patients with AF died. The highest proportion of deaths was among those who had stroke and myocardial infarction (MI) — 55,1 and 52,9%, respectively, with permanent AF (51,4%), at the age of ≥80 years (66,4%). High all-cause and cardiovascular death risk was associated with the following factors: age (hazard ratio (HR)=1,04 and HR=1,06; p<0,001); prior stroke (HR=1,38; p=0,008 and HR=1,69; p=0,001); permanent AF (HR=1,36; p=0,02 and HR=1,61; p=0,009); diabetes (HR=1,67; p<0,001 and HR=1,43; p=0,015); systolic blood pressure <110 mm Hg (HR=1,96; p=0,001 and 1,82; p=0,035). Chronic obstructive pulmonary disease and low hemoglobin levels were associated with a high all-cause mortality only (HR=2,02; p=0,001 and HR=1,49; p=0,018), and prior MI was associated with a cardiovascular death risk only (HR=1,32; p=0,043). The proportion of deaths was lowest among those discharged from cardiology departments (excluding emergency cardiology) — 33,7% and internal medicine departments — 37,0%, and the highest among those discharged from neurology departments — 54,9%, emergency cardiology departments — 56,7%, and surgical departments — 47,9%. Conclusion . Over 10 years after discharge from a multidisciplinary hospital, 43,9% of patients with AF died. The mortality rate was highest in AF with prior stroke and MI, with permanent AF, and at an age of ≥80 years. Prognostically unfavorable factors also included diabetes, chronic obstructive pulmonary disease, low hemoglobin levels, and systolic blood pressure <110 mm Hg. The lowest mortality rate was among patients discharged from cardiology (excluding emergency cardiology) and internal medicine departments, and the highest one was among those discharged from emergency cardiology, neurology, and surgery departments.