P6545Does rhythm matter in acute heart failure? An insight into clinical outcomes from the British Society for Heart Failure national audit

Abstract

Background: Atrial fibrillation (AF) is the most common sustained arrhythmia in patients with acute Heart Failure (AHF). The presence of AF is associated with adverse prognosis in patients with chronic Heart Failure (CHF) but little is known about its impact in acute Heart Failure. Method(s): Data was collected between April 2007 to March 2013 across 185 (>95%) hospitals in England & Wales for patients with a primary death from, or a discharge diagnosis of AHF. We investigated the association between the presence of AF and all-cause mortality during the index hospital admission and at 30 days and 1 year post-discharge using shared frailty Cox proportional hazard models. Result(s): Of 96,593 patients admitted with AHF, 44,642 (46%) were in sinus rhythm (SR) and 51,951 (54%) in AF. Patients with AF were older (mean age 79.8 (79.7-80) versus 74.7 (74.5-74.7) years; p<0.001), but had a lower prevalence of diabetes, acute myocardial infarction and left ventricular systolic dysfunction (LVSD) than those in SR. In a multivariable analysis, AF was independently associated with mortality at all time points, in hospital (HR 1.15, 95% CI 1.09- 1.21, p<0.0001), 30 days (HR 1.13, 95% CI 1.08-1.19, p<0.0001), and 1 year (HR 1.09, 95% CI 1.05-1.12, p<0.0001). In subgroup analyses, AF was independently associated with worse 30 days outcome irrespective of sex, ventricular phenotype and in all age groups except in those who aged between 55-74 years (Hazard ratio 1.04 (CI 0.85-1.29, p=0.69). Conclusion(s): AF is independently associated with adverse prognosis in AHF during admission and up-to one-year post discharge. As the clinical burden of concomitant AF and AHF increases, further refinement in the detection, treatment and prevention of AF-related complications are necessary to effectively improve patient outcome.