Increased 1-year mortality rates among elderly hip fracture patients with atrial fibrillation

Prediction of factors associated with survival following hip fracture is important. We studied crude and adjusted survival rates in elderly hip fracture patients with and without atrial fibrillation (AF) to assess possible risk of death associated with AF.

A historical prospective cohort study, comprising 1114 consecutive patients with hip fractures. Subjects were divided into three groups: patients with sinus rhythm (SR), paroxysmal atrial fibrillation (PAF) or chronic atrial fibrillation (CAF). The main outcome measures were crude and adjusted survival rates at 30, 90 and 365 days, and end of follow-up.

AF patients differed from SR patients by gender (p=0.0018), age (p=0.008), heart failure (p<0.001), ischemic heart disease (p<0.001) and history of a stroke (p<0.001). The lowest death rates were observed among SR and PAF patients, whereas CAF patients had the highest rates at each follow-up time point. CAF (but not PAF or SR) patients were at a significantly higher risk of death at both 365 days and at the end of the study (HR 1.786, CI 1.011- 3.155 and HR 1.835, CI 1.302-2.585, respectively). Older age (HR 1.301, CI 1.135-1.491 and HR 1.321, CI 1.321-1.415) and male gender (HR 1.879, CI 1.271- 2.779 and HR 1.545, CI 1.251-1.909) also predicted higher risk of death at both 365 days and at the end of the study.

Atrial fibrillation cannot be considered to adversely affect short-term survival of hip fracture patients. After 365 day, CAF was associated with a significantly higher risk of death.