Atrial Fibrillation and Adverse Hospital Outcomes in Adult Patients with Acute Heart Failure: An Observational Study

Introduction: Acute heart failure is a major cause of hospitalization worldwide and is associated with significant morbidity and mortality. Atrial fibrillation, a common comorbidity in acute heart failure, may adversely influence clinical outcomes; however, data from low- and middle-income countries, including Nepal, remain limited. This study aimed to determine the prevalence of atrial fibrillation and evaluate its association with in hospital outcomes among patients admitted with acute heart failure.Methods: This hospital-based cross-sectional study was conducted in two tertiary care centers in Kathmandu, Nepal, over one year. A total of 156 patients aged ≥18 years admitted with acute heart failure were included. Data on demographics, comorbidities, and echocardiographic parameters were collected. Adverse hospital outcomes were defined as a composite of in-hospital mortality, acute kidney injury and stroke.Results: The mean age of patients was 62±11.50 years, with 85 (54.48%) males. Reduced ejection fraction (<40%) was observed in 96 (61.53%) of patients. Hypertension 50 (32.12%), diabetes 44 (28.21%), and smoking 41 (26.31%) were common risk factors. Valvular heart disease was seen as cause in 59 (37.82%) cases. Adverse hospital outcomes occurred in 49 (31.41%) patients; acute kidney injury, mortality and stroke were 36 (23.07%), 11 (7.05%) and 2 (1.28%) patients respectively. Atrial fibrillation was seen in 60 (38.46%) patients and was significantly associated with adverse outcomes compared to non-AF patients (p<001). Conclusions: Atrial fibrillation is significantly associated with worse in-hospital outcomes in patients with acute heart failure, highlighting the need for early identification and aggressive management.