Determinants of short-term outcome of mortality among heart failure patients with atrial fibrillation in a tertiary hospital of Kano, North-Western Nigeria

Abstract

Introduction: Atrial fibrillation (AF) is the most common sustained arrhythmia that is encountered in clinical practice and is associated with increased risk of stroke and death. Because both heart failure (HF) and AF are associated with significant morbidity and mortality, their coexistence identifies individuals at higher mortality risk. We set out to describe the determinants of short-term outcome of mortality among HF patients with AF in Aminu Kano Teaching Hospital (AKTH), Kano, Nigeria. Methodology: We conducted a longitudinal study of all adults aged 18 years and above who presented at AKTH, Kano, within the study period and were hospitalized for HF. Those who consented were consecutively recruited into the study. Sociodemographic, clinical, laboratory, electrocardiographic, and echocardiographic characteristics of patients at presentation were documented. We divided the patients into two groups: Those with AF and those with sinus rhythm (SR). We followed both groups for 3 months to look for the causes of mortality for each of the groups. In addition, we documented the determinants of mortality among the AF group. Data analysis was done using Statistical Package for the Social Sciences (SPSS) application version 20. Results: Out of the 30 HF patients with AF studied, 17 (56.7%) died within the period of follow-up. In bivariate analysis, we found mortality among patients with AF was associated with high New York Heart Association functional class and nontreatment with Vitamin K antagonist (warfarin). In multivariate analysis, nontreatment with warfarin was the only independent predictor of death among the HF patients with AF, with odds of dying 19-times higher among patients who did not receive warfarin compared to those who received it (adjusted odds ratio = 19.4, 95% confidence interval = 2.6–148). Conclusion: HF patients with AF have high mortality and nontreatment with warfarin is an independent predictor of that mortality. However, more studies with larger sample size are needed in our country to fully study the determinants of short-term outcomes of HF patients with AF.