The interplay between atrial fibrillation and heart failure on long-term mortality and length of stay: Insights from the, United Kingdom ACALM registry

Ziff, Oliver J.; Carter, Paul R.; McGowan, John; Uppal, Hardeep; Chandran, Suresh; Russell, Stuart D.; Bainey, Kevin R.; Potluri, Rahul

doi:10.1016/j.ijcard.2017.06.033

Cited by 43 publications

(31 citation statements)

References 38 publications

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“…We explored thirteen candidate predictors for their contributions to the total LOS. All pre-selected risk factors and their cutoffs were chosen based on previous studies which addressed their association with prolonged LOS or mortality: age > 65 years [ 20 ], male gender [ 21 ], chronic kidney disease [ 10 ], ischemic heart disease [ 10 ], diabetes mellitus [ 10 ], atrial fibrillation [ 22 ], NYHA functional class III/IV [ 8 ], systolic blood pressure < 100 or > 140 [ 23 ], respiratory rate > 24 per minute [ 24 ], ProBNP ≥ 1800 pg/mL [ 17 ], serum sodium < 135 mmol/L [ 25 ], hemoglobin < 10 g/dL [ 26 ], and serum albumin < 3.5 g/dL [ 21 ].…”

Section: Methodsmentioning

confidence: 99%

Clinical Predictors Influencing the Length of Stay in Emergency Department Patients Presenting with Acute Heart Failure

et al. 2020

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Background and objectives: Acute heart failure is a common problem encountered in the emergency department (ED). More than 80% of the patients with the condition subsequently require lengthy and repeated hospitalization. In a setting with limited in-patient capacity, the patient flow is often obstructed. Appropriate disposition decisions must be made by emergency physicians to deliver effective care and alleviate ED overcrowding. This study aimed to explore clinical predictors influencing the length of stay (LOS) in patients with acute heart failure who present to the ED. Materials and Methods: We conducted prognostic factor research with a retrospective cohort design. Medical records of patients with acute heart failure who presented to the ED of Ramathibodi Hospital from January to December 2015 were assessed for eligibility. Thirteen potential clinical predictors were selected as candidates for statistical modeling based on previous reports. Multivariable Poisson regression was used to estimate the difference in LOS between patients with and without potential predictors. Results: A total of 207 patients were included in the analysis. Most patients were male with a mean age of 74.2 ± 12.5 years. The median LOS was 54.6 h (Interquartile range 17.5, 149.3 h). From the multivariable analysis, four clinical characteristics were identified as independent predictors with an increase in LOS. These were patients with New York Heart Association (NYHA) functional class III/IV (+72.9 h, 95%Confidence interval (CI) 23.9, 121.8, p = 0.004), respiratory rate >24 per minute (+80.7 h, 95%CI 28.0, 133.3, p = 0.003), hemoglobin level <10 mg/dL (+60.4 h, 95%CI 8.6, 112.3, p = 0.022), and serum albumin <3.5 g/dL (+52.8 h, 95%CI 3.6, 102.0, p = 0.035). Conclusions: Poor NYHA functional class, tachypnea, anemia, and hypoalbuminemia are significant clinical predictors of patients with acute heart failure who required longer LOS.

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Section: Methodsmentioning

confidence: 99%

Clinical Predictors Influencing the Length of Stay in Emergency Department Patients Presenting with Acute Heart Failure

et al. 2020

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“…New-onset AF or HF was associated with significantly worse prognosis than longstanding disease. 11 Another study found that higher admission heart rate (HR) was independently associated with worse outcomes in patients admitted for HF, both for those in sinus rhythm and AF. 12 In the randomised Beta-blocker Evaluation of Survival Trial (BEST), patients with HFrEF who developed new-onset AF were found to exhibit a two-fold increase in mortality and a 4.5-fold increase in all-cause or HF hospitalization, compared with patients who did not develop AF.…”

Section: Prognosis and Outcomes In New Onset And Pre-existing Afmentioning

confidence: 99%

Atrial fibrillation in acute heart failure: A position statement from the Acute Cardiovascular Care Association and European Heart Rhythm Association of the European Society of Cardiology

Görenek

Halvorsen

Kudaiberdieva³

et al. 2020

European Heart Journal: Acute Cardiovascular Care

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Atrial fibrillation and acute heart failure frequently co-exist and can exacerbate each other. Their combination leads to increased morbidity and mortality. However, the prevalence and significance, as well as the treatment, of atrial fibrillation in acute heart failure are not well studied. Management of atrial fibrillation in acute heart failure requires a multidisciplinary team approach. Treatment of underlying disease(s), identification and treatment of potentially correctable causes and precipitating factors and anticoagulation are crucial. In this article, current evidence on atrial fibrillation in the setting of acute heart failure is summarised. The recommendations on management of atrial fibrillation in the prehospital stage, the treatment of reversible causes, when and how to use rate or rhythm control, maintenance of sinus rhythm, catheter ablation and pacing, anticoagulation, as well as measures on prevention of atrial fibrillation are provided.

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“…AF is a worldwide epidemic involving nearly 50% of patients with advanced HF [6]. Some meta-analyses have shown that coexistence of HF and AF is associated with higher all-cause mortality over time compared with those with single disease, and the worse prognosis is independent from the severity of systolic dysfunction [7-10]. In detail, the original Framingham Heart Study showed that in 1,737 individuals, 37% of de novo AF was in patients with HF, while 57% of de novo HF was in patients with AF [11].…”

Section: Af In Advanced Hfmentioning

confidence: 99%

Insight into Atrial Fibrillation in LVAD Patients: From Clinical Implications to Prognosis

Sisti¹,

Mandoli²,

Sciaccaluga³

et al. 2020

Pulse

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The use of left ventricular assist devices (LVADs), whether for destination therapy or bridge to transplantation, has gained increasing validation in recent years in patients with advanced heart failure. Arrhythmias can be the most challenging variables in the management of such patients but the main attention has always been focused on ventricular arrhythmias given the detrimental impact on mortality. Nevertheless, atrial fibrillation (AF) is the most common rhythm disorder associated with advanced heart failure and may therefore characterize the LVADs' pre-and postimplantation periods. Indeed, the consequences of AF in the population suffering from standard heart failure may require a more comprehensive evaluation in the presence of or in sight of an LVAD, making the AF clinical management in these patients potentially complex. Several studies have been based on this subject with different and often conflicting results, leaving many questions unresolved. The purpose of this review is to summarize the main pieces of evidence about the clinical impact of AF in LVAD patients, underlining the main implications in terms of hemodynamics, thromboembolic risk, bleeding and prognosis. Therapeutic considerations about the clinical management of these patients are also made according to the latest evidence.

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The interplay between atrial fibrillation and heart failure on long-term mortality and length of stay: Insights from the, United Kingdom ACALM registry

Abstract: Patients with HF in AF are at a greater risk of mortality and longer hospital stay compared to patients without the combination. New-onset AF or HF is associated with significantly worse prognosis than long-standing disease.

Cited by 43 publications

References 38 publications

Clinical Predictors Influencing the Length of Stay in Emergency Department Patients Presenting with Acute Heart Failure

Clinical Predictors Influencing the Length of Stay in Emergency Department Patients Presenting with Acute Heart Failure

Atrial fibrillation in acute heart failure: A position statement from the Acute Cardiovascular Care Association and European Heart Rhythm Association of the European Society of Cardiology

Insight into Atrial Fibrillation in LVAD Patients: From Clinical Implications to Prognosis

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