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Interplay of Atrial Arrhythmia and Chronic Heart Failure: A Population-Based Analysis of Hospital Outcomes in Germany
Anastasia Janina Hobbach1, Jannik Feld2, Jürgen Reinhard Sindermann1
1Department of Cardiology I, Coronary, Peripheral Vascular Disease and Heart Failure, University Hospital Münster, Münster, Germany.
Insights
Atrial fibrillation or flutter (AFl) is common in chronic heart failure (CHF) patients, often indicating more severe disease. Its effect on in-hospital mortality is complex and varies by age, requiring personalized care strategies.
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- Atrial fibrillation or flutter (AFl) frequently coexists with chronic heart failure (CHF).
- The impact of AFl on in-hospital outcomes in large, unselected CHF populations is not well-defined.
- Understanding this relationship is crucial for optimizing patient care and resource allocation.
Purpose of the Study:
- To investigate the association between AFl and in-hospital outcomes in a large cohort of patients hospitalized for CHF.
- To identify predictors of mortality in CHF patients with and without AFl.
- To inform clinical management strategies for CHF patients with comorbid AFl.
Main Methods:
- Nationwide administrative data from German hospitalizations for CHF (ICD-10-GM I50*) between 2014 and 2022 were analyzed.
- Patients were stratified into groups with and without AFl.
- Outcomes included in-hospital mortality, complications, length of stay, and costs. Multivariable logistic regression identified mortality predictors.
Main Results:
- AFl was present in 56.9% of 4,057,291 CHF hospitalizations.
- AFl patients were older, more female, and had higher comorbidity burden (CKD, hypertension, stroke).
- AFl was linked to higher complication rates (AKI, cardiogenic shock) but lower mortality overall (8.30% vs. 8.66%), though multivariable analysis showed age-dependent increased mortality risk.
Conclusions:
- AFl is prevalent in CHF hospitalizations and associated with more advanced disease.
- The impact of AFl on in-hospital mortality is complex and age-dependent.
- Tailored clinical management is essential for CHF patients with coexisting AFl.
Aims:
Atrial fibrillation or flutter (AFl) frequently coexists with chronic heart failure (CHF), yet its impact on in-hospital outcomes in large, unselected populations remains insufficiently defined.
Methods:
We analyzed all hospitalizations for CHF (ICD-10-GM I50*) in Germany from 2014 to 2022 using nationwide administrative data. Patients were stratified by rhythm status (AFl vs. non-AFl). Outcomes included in-hospital mortality, complications, length of stay, and health care costs. Multivariable logistic regression was used to identify independent predictors of mortality.
Results:
Among 4,057,291 hospitalizations, 56.9% had AFl. These patients were older (median 82 vs. 79 years), more often female, and showed a higher comorbidity burden, particularly CKD, hypertension, and stroke. AFl was associated with higher rates of complications such as AKI (11.9% vs. 9.7%; p < 0.001) and cardiogenic shock (1.15% vs. 1.03%; p < 0.001), but lower use of mechanical ventilation and assist devices. Despite this, in-hospital mortality was slightly lower in AFl (8.30% vs. 8.66%). AFl patients had longer median hospital stays (8 vs. 7 days), while costs were comparable. Ventilated AFl patients had longer ventilation times (28 vs. 21 hours). In multivariable analysis, AFl was independently associated with higher mortality in most age groups, except for patients aged 40-49, 80-89, and > 90 years.
Conclusions:
In this nationwide cohort, AFl was common among CHF patients and linked to more advanced disease. Its impact on in-hospital mortality was age-dependent and complex, highlighting the need for tailored clinical management.
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