Key result
Sinus rhythm at discharge for AF is linked to ~21% lower out-of-hospital mortality.
Why the study?
Recent trials correlate sinus rhythm restoration with a better prognosis than rate control in atrial fibrillation, but its overall impact on post-discharge all-cause mortality after hospitalization for AF required further research.
Does sinus rhythm restoration at discharge reduce all-cause post-discharge mortality in patients hospitalized for atrial fibrillation?
Cohort (n=3,644)
Yes
Does sinus rhythm restoration at discharge reduce all-cause post-discharge mortality in patients hospitalized for atrial fibrillation?
Restoration of sinus rhythm prior to hospital discharge in patients admitted for atrial fibrillation is independently associated with reduced long-term all-cause mortality, supporting the prognostic benefit of rhythm-control strategies.
Introduction Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with increased morbidity and mortality. Recent trials correlate sinus rhythm (SR) restoration with better prognosis than rate control, but its overall impact on all-cause mortality demands further research. Purpose To assess the correlation of SR restoration with the reduction of post-discharge mortality in patients hospitalized due to AF. Methods We retrospectively analyzed data from a large multicenter cardiovascular registry. Adult patients discharged with a diagnosis of AF and with an available admission electrocardiogram (ECG) confirming AF, and an available discharge ECG, regardless of the rhythm, were included. Follow-up for up to 10-year out-of-hospital mortality was obtained through national outcome and prescription registers. The primary outcome was all-cause mortality after discharge, and the main exposure was SR on the discharge ECG. Multivariable logistic regression, Cox proportional hazards models, and Kaplan–Meier survival analyses were performed, adjusting for demographic characteristics, clinical comorbidities, and rhythm-control strategies. Results A total of 3,644 patients hospitalized for AF were included (47.3% female; mean age 74.4 ± 11.6 years). SR at discharge was present in 34.0% of the patients. During follow-up, SR at discharge was independently associated with a significantly lower risk of out-of-hospital mortality (adjusted OR 0.63, 95% CI 0.43–0.91, p = 0.014; adjusted HR 0.79, 95% CI 0.66–0.94, p = 0.007). Kaplan–Meier curves demonstrated longer survival among patients discharged in SR (log-rank p < 0.001), with a mean survival of 3,671 vs 2,244 days, respectively. Median survival was reached only in the non–sinus rhythm group (1,330 days). Conclusion SR restoration in patients hospitalized for AF was associated with lower mortality rates, independently of confounders. This finding supports the potential benefit of rhythm control strategies in improving long term prognosis in patients with AF.
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Alexandrou et al. (2026) conducted a cohort in Atrial fibrillation (n=3,644). Sinus rhythm restoration on discharge ECG vs. Non-sinus rhythm on discharge ECG was evaluated on Out-of-hospital all-cause mortality after discharge (HR 0.79, 95% CI 0.66-0.94, p=0.007). Sinus rhythm at discharge in patients hospitalized for AF was associated with lower out-of-hospital mortality (adjusted HR 0.79, 95% CI 0.66-0.94, p=0.007; adjusted OR 0.63, p=0.014).
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