Mortalidad y fibrilación auricular en el estudio FIACAevidencia de un efecto diferencial según el diagnóstico al alta hospitalaria

Abstract

Introduction and objectives: atrial fibrillation is an independent risk factor for mortality in several diseases. However, data published in acute decompensated heart failure are contradictory. Our objective was to investigate the impact of atrial fibrillation on mortality in patients admitted to hospital for decompensated heart failure compared with those admitted for other reasons. Methods: this retrospective cohort study included all patients admitted to hospital within a 10-year period due to decompensated heart failure, acute myocardial infarction , or ischemic stroke , with a median follow-up of 6.2 years. Results: we included 6613 patients (74 ± 11 years; 54.6% male); 2177 with acute myocardial infarction, 2208 with decompensated heart failure, and 2228 with ischemic stroke. Crude postdischarge mortality was higher in patients with atrial fibrillation hospitalized for acute myocardial infarction (incident rate ratio, 2.48; P < .001) and ischemic stroke (incident rate ratio, 1.84; P < .001) than in those without atrial fibrillation. No differences were found in patients with decompensated heart failure (incident rate ratio, 0.90; P = .12). In adjusted models, atrial fibrillation was not an independent predictor of in-hospital mortality by clinical diagnosis. However, atrial fibrillation emerged as an independent predictor of postdischarge mortality in patients with acute myocardial infarction (hazard ratio, 1.494; P = .001) and ischemic stroke (hazard ratio, 1.426; P < .001), but not in patients admitted for decompensated heart failure (hazard ratio, 0.964; P = .603). Conclusions: atrial fibrillation was as an independent risk factor for postdischarge mortality in patients admitted to hospital for acute myocardial infarction and ischemic stroke but not in those admitted for decompensated heart failure.