Clinical Profile, Management Patterns, and In-Hospital Outcomes Among Patients Hospitalized With Atrial Fibrillation...

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia worldwide and is associated with substantial morbidity, mortality, recurrent hospitalization, and healthcare expenditure.

This study aimed to evaluate the clinical characteristics, management patterns, and in-hospital outcomes of patients hospitalized with AF and to identify factors associated with in-hospital mortality.

This retrospective observational study included consecutive adult patients (≥18 years) with electrocardiographically confirmed AF admitted to Shalamar Hospital, Lahore, Pakistan, between January 1, 2023, and January 1, 2026. Demographic characteristics, comorbidities, echocardiographic findings, treatment modalities, and in-hospital outcomes were extracted from medical records. The primary outcome was in-hospital mortality. Secondary outcomes included stroke, systemic embolism, major bleeding, heart failure exacerbation, intensive care unit admission, and length of hospital stay. Univariable and exploratory multivariable logistic regression analyses were performed, and adjusted odds ratios (ORs) with 95% confidence intervals (CIs) were reported.

A total of 282 patients were included (mean age, 68.4 ± 11.9 years; 58.5% male patients). Hypertension (70.2%), diabetes mellitus (44.7%), ischemic heart disease (40.4%), and heart failure (34.8%) were the most common comorbidities. Persistent AF was the most frequent subtype (36.5%), while paroxysmal and permanent AF comprised 29.8% and 33.7% of cases, respectively. Rate-control therapy was administered to 88.3% of patients, and anticoagulation to 80.5% (direct oral anticoagulants 52.5%; warfarin 28.0%). In-hospital mortality was 5.7%. Exploratory multivariable analysis demonstrated that age ≥75 years (adjusted OR, 2.48; 95% CI, 1.08-5.71; p = 0.032), heart failure (adjusted OR, 2.91; 95% CI, 1.24-6.82; p = 0.014), chronic kidney disease (adjusted OR, 3.67; 95% CI, 1.49-9.01; p = 0.005), and LVEF <40% (adjusted OR, 2.74; 95% CI, 1.17-6.41; p = 0.020) were associated with in-hospital mortality.

Hospitalized patients with AF were predominantly older adults with multiple cardiovascular comorbidities and experienced considerable in-hospital morbidity despite contemporary management. Advanced age, heart failure, chronic kidney disease, and reduced left ventricular ejection fraction were associated with in-hospital mortality. These findings may help identify patients requiring closer inpatient monitoring and optimized evidence-based management; however, larger prospective multicenter studies are needed to validate these associations.