Association of atrial fibrillation and acute heart failure in emergency medicine: determinants of in-hospital death

Background: the presence of atrial fibrillation (AF) and acute heart failure (AHF) is associated to a significantly increased risk of death, especially in elderly patients. Patients and Methods: we retrospectively enrolled all the consecutive patients admitted for AF in our subintensive medicine department in the period 2002- 2007. Among these, we selected those affected by AHF. In this group, we evaluated the prevalence of both concomitant acute disorders and chronic comorbidities. Particularly, we investigated, among the acute events complicating the admission: acute coronary syndromes (ACS), cardiogenic shock (CS), septic shock (SS), acute respiratory insufficiency (ARI), acute kidney injury (AKI), infections (INF), thromboembolic complications (THR) and major haemorrhages (MH). We also assessed the presence of chronic heart failure (CHF), chronic kidney disease (CKD), active cancer (AC), COPD, coronary artery disease (CAD), peripheral artery disease (PAD), type 2 diabetes mellitus (T2DM), cerebrovascular disease (CVD), chronic anaemia (CA), chronic hepatic diseases (CH) and hypertension (HYP). We adopted in-hospital death as main outcome and age, sex, concomitant acute and chronic events as predictors in a binary logistic multivariate model. Prevalence of each disease and the risk of in-hospital death were drawn in a solar-system graph, called \u201ccomorbidome\u201d, already adopted in other studies (Figure 1). Results: we obtained a final sample of 776 AF/AHF coaffected patients (age:80. 32\ub18. 32; males:46. 3%) with 78 (10. 0%) deaths. Increasing age (OR:1. 08;95%CI:1. 04-1. 13), but none of the chronic comorbidities were significantly associated to higher risk of in-hospital death. Among the acute conditions complicating the admission, ACS (OR:2. 12;95%CI:1. 00-4. 49), CS (OR:37. 47;95%CI:12. 16-115. 49), HS (OR:42. 31; 95%CI:5. 74-311. 77), SS (OR:9. 72; 95%CI:4. 47-21. 14), ARI (OR:4. 05;95%CI:1. 99-8. 23) and THR (OR:1. 410;95%CI:1. 04-1. 91) were significantly connected to an increased risk of in-hospital death. Discussion: chronic pathologies are common among elderly patients admitted for AF/AHF, however age seems to be the most important determinant of prognosis. Some acute events, by complicating the clinical course, can significantly increase the risk of death in this specific group