Purpose: The aim of the study was to identify clinical predictors of one-year outcome of patients (pts) hospitalized for heart failure (HF), depending on whether they were in sinus rhythm (SR) or had atrial fibrillation (AF).
Methods: The study included Polish pts hospitalized for HF participating in the Heart Failure Pilot Survey of the European Society of Cardiology, who were followed for 12 months after discharge. Pts with paced heart rhythm were excluded from the study. The primary endpoint was all-cause death at 12 months.
Results: The final analysis included 587 pts. AF occurred in 215 pts (36.6%). Compared to pts with SR, pts with AF were older; more often had a history of previous HF hospitalization; were less likely to smoke; were more frequently treated with aldosterone antagonists, loop diuretics, anticoagulants and digoxin but less frequently with antiplatelets before index hospitalization; were characterized by a higher NYHA class; higher heart rate and lower diastolic blood pressure at hospital admission; had higher serum creatinine and lower hemoglobin concentration at admission; less frequently had coronary angioplasty or coronary artery bypass grafting performed during index hospitalization; had higher heart rate at discharge; were more often prescribed anticoagulants and digoxin but less often statins, angiotensine-converting enzyme inhibitors and antiplatelets at discharge. There was no significant difference between pts with AF and pts with SR in terms of in-hospital mortality (5.1% vs 2.4%, respectively; p = 0.1). The primary endpoint occurred in 41 of 215 of AF pts (19.1%) and in 40 of 372 SR pts (10.8%; p = 0.006). In a multivariate analysis, independent predictors of the primary endpoint in AF pts were: higher NYHA class (HR 1.95; 95%CI 1.11-3.42; p = 0.02) and heart rate (HR 1.02; 95%Cl 1.00-1.03; p = 0.04) and lower serum sodium concentration at admission (HR 0.89; 95%CI 0.85-0.94; p = 0.0001) and higher heart rate at discharge (HR 1.02; 95%Cl 1.01-1.04; p = 0.01). In pts with SR, independent predictors of the primary endpoint included: older age (HR 1.04; 95%Cl 1.01-1.07; p = 0.007), lower serum sodium concentration at admission (HR 0.86; 0.80-0.94; p = 0.0006) and higher heart rate at discharge (HR 1.03; 1.01-1.05; p = 0.01).
Conclusions: In the studied group of real-world HF pts, serum sodium concentration at hospital admission and heart rate at hospital discharge were independent prognostic factors in both, pts with AF and pts with SR. In contrast to pts with SR, in AF pts, heart rate at hospital admission was also predictive of long-term mortality.