The clinical implication of new‐onset in‐hospital atrial fibrillation in patients with acute decompensated heart failure

• Main Authors: Masashi Kamioka, Akiomi Yoshihisa, Minoru Nodera, Tomofumi Misaka, Tetsuro Yokokawa, Takashi Kaneshiro, Kazuhiko Nakazato, Takafumi Ishida, Yasuchika Takeishi
• Format: Article
• Language: English
• Published: Wiley 2020-10-01
• Series: Journal of Arrhythmia
• Subjects: acute heart failure; atrial fibrillation after discharge; cardiac death; cerebrovascular event; new‐onset in‐hospital atrial fibrillation
• Online Access: https://doi.org/10.1002/joa3.12386
• ISSN: 1880-4276; 1883-2148

Abstract Background To investigate the clinical implication of the temporal difference in atrial fibrillation (AF)‐onset in acute decompensated heart failure (ADHF) and its impact on post‐discharge prognosis. Methods 336 new‐onset ADHF patients without any history of AF before admission were enrolled (201 males, 63 ± 16 year‐old) and classified into two groups based on their history of AF: the Control group (No AF was detected during hospitalization, n = 278), and the In‐hos‐AF group (AF occurred during hospitalization, n = 58). Post discharge prognosis including rehospitalization due to worsening HF, cardiac death, all‐cause death and cerebrovascular event were compared. Results Kaplan‐Meier analysis demonstrated that the incidence of rehospitalization due to HF, cardiac death, all‐cause death and cerebrovascular event in the In‐hos‐AF group was not significantly different from that in the Control group (P > 0.05 respectively). However, when AF recurred in the In‐hos‐AF group patients (n = 24, 41%) after discharge, the incidence of rehospitalization due to HF and cardiac deaths were higher than those without AF recurrence (P = 0.018 and P = 0.027 respectively). Cox proportional analysis revealed that AF developing after discharge was proven to be an independent risk factor for rehospitalization due to HF (HR 1.845, P = 0.043), cardiac death (HR 3.562, P = 0.013) and all‐cause deaths (HR 2.138, P = 0.020). Conclusion Clinical outcomes of new‐onset in‐hospital AF patients were as good as those without AF history until AF recurrence. However, AF recurrence led to worse prognosis. Therefore, treatment for new‐onset in‐hospital AF in ADHF patients might be postponed until AF recurrence.