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Introduction: Atrial fibrillation (AF) adversely affect the outcomes in the patients of heart failure (HF) with reduced ejection fraction, however there are limited data exploring such an association in HF with preserved ejection fraction (HFpEF). Hypothesis: AF is associated with worse outcomes in HFpEF. Methods: We included all the patients with the primary diagnosis of HFpEF from the national inpatient sample (NIS) database (2012-2014) using ICD-9 codes. Exposure of interest was AF. Primary outcome was in-hospital mortality and secondary outcomes were rates of sudden cardiac arrest (SCA), syncope, cardiogenic shock, embolic stroke, acute myocardial infarction (AMI), acute kidney injury (AKI), passive hepatic congestion, ventricular fibrillation (V fib) and flutter, ventricular assist device (VAD), AICD, cardiac resynchronization therapy (CRT), intra-aortic balloon placement (IABP) placement and heart transplantation. Hospitalization cost was also studied. Results: Our study cohorts included 26,51,970 patients of HFpEF with AF and 37,44,101 patients of HFpEF without AF. AF cohort had more numbers of older patients and less female representation. In-hospital mortality was more in AF cohort. Similarly, the odds of SCA, cardiogenic shock, embolic stroke, passive hepatic congestion, Vfib and flutter, AICD and CRT placement were higher in AF cohort. The odds of syncope, AMI and AKI were lower in AF cohort as compared to non-AF cohort. While the odds of heart transplantation and VAD and IABP use remained comparable between the study cohorts, AF cohort incurred greater of cost of hospitalization. Conclusion: AF in HFpEF patients is associated with increased in-hospital mortality and cardiogenic shock and should be aggressively treated for improved outcomes.

Introduction: The association between serum albumin level and the risk of contrast-induced acute kidney injury (CI-AKI) after coronary angiography has not been well established. Material and methods: A retrospective chart review was performed for all patients who underwent coronary angiography with or without percutaneous coronary intervention (PCI) at a tertiary care medical center over a period of 5 years. CI-AKI was defined as an absolute increase in creatinine of 0.3 mg/dl from baseline within 48 h of contrast exposure. Mean pre-procedural albumin level was compared between patients who developed CI-AKI and those who did not. The optimal cut-off point was obtained from the receiver operating characteristic (ROC) curve and univariate multiple logistic regression analysis was used to assess the associated risk of CI-AKI. Results: Among 1319 patients (females = 32.3%, mean age: 58.2 ± 13.6 years) included in the study, 201 (15.2%) developed CI-AKI. Baseline serum albumin (3.5 vs. 3.8 gm/dl, p < 0.001) was significantly lower in patients who developed CI-AKI. ROC curve analysis revealed an optimal cutoff value for serum albumin of 3.85 gm/dl to predict CI-AKI with 67.2% sensitivity and 52.2% specificity (area under the curve (AUC) = 0.62, p < 0.001). Serum albumin < 3.85 gm/dl is significantly associated with higher risk of developing CI-AKI (adjusted odds ratio (AOR) = 1.5, 95% CI: 1.1-2.1, p = 0.02). Conclusions: Serum albumin < 3.85 gm/dl is an independent predictor of CI-AKI in patients undergoing coronary angiography.