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The role of atrial fibrillation in the short-term outcomes of patients with acute heart failure

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Abstract

Aims

To investigate whether the presence of atrial fibrillation (AF) is independently associated with adverse short-term outcomes in patients diagnosed with acute heart failure (AHF) in the emergency department (ED).

Methods

We performed a secondary analysis of patients included in the EAHFE registries 4&5. Patients were divided by the presence of sinus rhythm (SR) or AF at ED arrival. The primary outcome was 30-day all-cause mortality. Secondary outcomes included the 30-day post-discharge combined endpoint of ED revisit or hospitalisation due to AHF and all-cause mortality. We recorded 54 independent variables that can affect outcomes. Cox regression was used to investigate adjusted significant associations between AF and outcomes. Analyses were repeated according to whether AF was previously known and whether AF was considered responsible for the AHF episode.

Results

We analysed 6045 ED visits (mean age 80.4 years, 55.9% women), 3644 (60.3%) with AF. The cumulative 30-day mortality was 9.4%, and the adverse combined endpoint (ACE) was 25.9% (ED revisit with and without hospitalisation were 16.5 and 8.9% and death occurred in 4.7%). No differences were found in outcomes of AHF patients with SR and AF, and among the latter group, no differences were found depending on whether AF was considered responsible for the AHF episode. Patients with previously known AF had significantly lower 30-day mortality and higher post-discharge ACE rates, although these differences disappeared after adjustment for confounders HR 0.782, 95% CI 0.590–1.037, p = 0.087; and HR 1.131, 95% CI 0.924–1.385, p = 0.234).

Conclusion

The coexistence of AF does not impact the short-term outcomes of patients diagnosed with AHF in the ED.

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Acknowledgements

This study was partially supported by grants from the Instituto de Salud Carlos III supported with funds from the Spanish Ministry of Health and FEDER (PI15/01019 and PI15/00773) and Fundació La Marató de TV3 (2015/2510). The “Emergencies: Processes and Pathologies” research group of the IDIBAPS receives financial support from the Catalonian Government for Consolidated Groups of Investigation (GRC 2009/1385 and 2014/0313).

Investigators of the ICA-SEMES (Research group on Acute Heart Failure of the Spanish Society of Emergency Medicine): Componentes del grupo ICA-SEMES: Marta Fuentes, Cristina Gil (Hospital Universitario de Salamanca), Héctor Alonso, Pablo Garmila (Hospital Marqués de Valdecilla de Santander), F. Javier Martín-Sánchez, Guillermo Llopis García, María Cecilia Yáñez-Palma, Sergio Iglesias López (Hospital Clínico San Carlos de Madrid), Òscar Miró, Víctor Gil, Rosa Escoda, Carolina Xipell, Carolina Sánchez, Josep María Gaytan (Hospital Clínic de Barcelona), María José Pérez-Durá, Eva Salvo (Hospital Politénic La Fe de Valencia), José Pavón (Hospital Dr. Negrín de Las Palmas de Gran Canaria), Antonio Noval (Hospital Insular de Las Palmas de Gran Canaria), José Manuel Torres (Hospital Reina Sofía de Córdoba), María Luisa López-Grima, Amparo Valero, Marian Ángeles Juan (Hospital Dr. Peset de Valencia), Alfons Aguirre, Maria Angels Pedragosa, Silvia Mínguez Masó (Hospital del Mar de Barcelona), María Isabel Alonso, Francisco Ruiz (Hospital de Valme de Sevilla), José Miguel Franco (Hospital Miguel Servet de Zaragoza), Ana Belén Mecina (Hospital de Alcorcón de Madrid), Josep Tost (Consorci Sanitari de Terrassa), Susana Sánchez, Virginia Carbajosa (Hospital Rio Ortega de Valladolid), Pascual Piñera, José Andrés Sánchez Nicolás (Hospital Reina Sofía de Murcia), Raquel Torres Garate (Hospital Severo Ochoa de Madrid), Aitor Alquezar, Miguel Alberto Rizzi, Sergio Herrera (Hospital de la Santa Creu i Sant Pau de Barcelona), Javier Jacob, Alex Roset, Irene Cabello (Hospital Universitari de Bellvitge de Barcelona), Fernando Richard, José María Álvarez Pérez, María Pilar López Diez. (Hospital Universitario de Burgos), Pablo Herrero-Puente, Joaquín Vázquez Álvarez, Belén Prieto García, María García García, Marta Sánchez González (Hospital Universitario Central de Asturias de Oviedo), Pere Llorens, Patricia Javaloyes, Víctor Marquina, Inmaculada Jiménez, Néstor Hernández, Benjamín Brouzet, Sergio Ramos, Ana López (Hospital General de Alicante), Juan Antonio Andueza (Hospital General Universitario Gregorio Marañón de Madrid), Rodolfo Romero (Hospital Getafe de Madrid), Martín Ruíz, Roberto Calvache (Hospital de Henares de Madrid), María Teresa Lorca, Luis Calderón (Hospital del Tajo de Madrid),Beatriz Amores Arriaga, Beatriz Sierra (Hospital Clínico Lozano Blesa de Zaragoza), Enrique Martín Mojarro (Hospital Sant Pau i Santa Tecla de Tarragona), Lisette Travería Bécquer, Guillermo Burillo (Hospital Universitario de Canarias de Tenerife), Lluís Llauger García, Gerard Corominas La Salle. (Hospital Universitari de Vic de Barcelona), Carmen Agüera Urbano, Ana Belén García Soto, Elisa Delgado Padial (Hospital Costa del Sol de Marbella de Málaga), Ester Soy Ferrer (Hospital Josep Trueta de Girona). Manuel Garrido (Hospital Virgen Macarena de Sevilla), Francisco Javier Lucas. (Hospital General de Albacete), Rut Gaya (Hospital Juan XXIII de Tarragona), Carlos Bibiano, María Mir, Beatriz Rodríguez, Natalia Sánchez (Hospital Infanta Leonor de Madrid), José Luis Carballo (Complejo Hospitalario Universitario de Ourense). Esther Rodríguez-Adrada, Belén Rodríguez (Hospital Rey Juan Carlos de Mostoles de Madrid).

Author information

Author notes

  1. Rodolfo Romero and Josep Mª Gaytan have equally contributed to this study and should both be considered as first author.

Authors and Affiliations

  1. Emergency Department, Hospital Universitario de Getafe, School of Biomedical and Health Sciences, Universidad Europea, Madrid, Spain

    Rodolfo Romero

  2. Emergency Department, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain

    Josep María Gaytán, Víctor Gil, Blanca Coll-Vinent & Òscar Miró

  3. Emergency Department, Hospital del Mar, Barcelona, Spain

    Alfons Aguirre

  4. Emergency Department, Short-Stay Unit and Home Hospitalization, Hospital General de Alicante, Medical School, University Miguel Hernández, Elx, Alicante, Spain

    Pere Llorens

  5. Emergency Department, Hospital Universitario Central de Asturias, Oviedo, Spain

    Pablo Herrero

  6. Emergency Department, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Spain

    Javier Jacob & Àlex Roset

  7. Emergency Department, Hospital Clínico San Carlos, Medical School, Universidad Complutense, Madrid, Spain

    Francisco Javier Martín-Sánchez

  8. Emergency Department, Hospital Universitario La Fe, Valencia, Spain

    María José Pérez-Durá

  9. Emergency Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain

    Aitor Alquézar

  10. Emergency Department, Hospital Doctor Peset, Valencia, Spain

    Maria Luisa López

  11. Emergency Department, Baylor College of Medicine, Houston, TX, USA

    W. Frank Peacock

  12. Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA, USA

    Judd E. Hollander

  13. Medical School, University of Barcelona, Barcelona, Spain

    Blanca Coll-Vinent & Òscar Miró

Authors
  1. Rodolfo Romero
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  2. Josep María Gaytán
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  3. Alfons Aguirre
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  4. Pere Llorens
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  5. Víctor Gil
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  6. Pablo Herrero
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  7. Javier Jacob
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  8. Francisco Javier Martín-Sánchez
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  9. María José Pérez-Durá
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  10. Aitor Alquézar
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  11. Maria Luisa López
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  12. Àlex Roset
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  13. W. Frank Peacock
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  14. Judd E. Hollander
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  15. Blanca Coll-Vinent
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  16. Òscar Miró
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Consortia

ICA-SEMES Research Group

  • Marta Fuentes
  • , Cristina Gil
  • , Héctor Alonso
  • , Pablo Garmila
  • , F. Javier Martín-Sánchez
  • , Guillermo Llopis García
  • , María Cecilia Yáñez-Palma
  • , Sergio Iglesias López
  • , Òscar Miró
  • , Víctor Gil
  • , Rosa Escoda
  • , Carolina Xipell
  • , Carolina Sánchez
  • , Josep María Gaytan
  • , María José Pérez-Durá
  • , Eva Salvo
  • , José Pavón
  • , Antonio Noval
  • , José Manuel Torres
  • , María Luisa López-Grima
  • , Amparo Valero
  • , Marian Ángeles Juan
  • , Alfons Aguirre
  • , Maria Angels Pedragosa
  • , Silvia Mínguez Masó
  • , María Isabel Alonso
  • , Francisco Ruiz
  • , José Miguel Franco
  • , Ana Belén Mecina
  • , Josep Tost
  • , Susana Sánchez
  • , Virginia Carbajosa
  • , Pascual Piñera
  • , José Andrés Sánchez Nicolás
  • , Raquel Torres Garate
  • , Aitor Alquezar
  • , Miguel Alberto Rizzi
  • , Sergio Herrera
  • , Javier Jacob
  • , Alex Roset
  • , Irene Cabello
  • , Fernando Richard
  • , José María Álvarez Pérez
  • , María Pilar López Diez
  • , Pablo Herrero-Puente
  • , Joaquín Vázquez Álvarez
  • , Belén Prieto García
  • , María García García
  • , Marta Sánchez González
  • , Pere Llorens
  • , Patricia Javaloyes
  • , Víctor Marquina
  • , Inmaculada Jiménez
  • , Néstor Hernández
  • , Benjamín Brouzet
  • , Sergio Ramos
  • , Ana López
  • , Juan Antonio Andueza
  • , Rodolfo Romero
  • , Martín Ruíz
  • , Roberto Calvache
  • , María Teresa Lorca
  • , Luis Calderón
  • , Beatriz Amores Arriaga
  • , Beatriz Sierra
  • , Enrique Martín Mojarro
  • , Lisette Travería Bécquer
  • , Guillermo Burillo
  • , Lluís Llauger García
  • , Gerard Corominas La Salle
  • , Carmen Agüera Urbano
  • , Ana Belén García Soto
  • , Elisa Delgado Padial
  • , Ester Soy Ferrer
  • , Manuel Garrido
  • , Francisco Javier Lucas
  • , Rut Gaya
  • , Carlos Bibiano
  • , María Mir
  • , Beatriz Rodríguez
  • , Natalia Sánchez
  • , José Luis Carballo
  • , Esther Rodríguez-Adrada
  •  & Belén Rodríguez

Corresponding author

Correspondence to Òscar Miró.

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Conflict of interest

The authors state that they have no conflict of interests with the present work. The ICA-SEMES Research Group has received unrestricted support from Orion Pharma and Novartis. The present study has been designed, performed, analysed and written exclusively by the authors independently of these pharmaceutical companies.

Additional information

ICA-SEMES Research Group members are listed in acknowledgements section.

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Romero, R., Gaytán, J.M., Aguirre, A. et al. The role of atrial fibrillation in the short-term outcomes of patients with acute heart failure. Clin Res Cardiol 108, 622–633 (2019). https://doi.org/10.1007/s00392-018-1389-x

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