Kamioka Masashi, Yoshihisa Akiomi, Nodera Minoru, Misaka Tomofumi, Yokokawa Tetsuro, Kaneshiro Takashi, Nakazato Kazuhiko, Ishida Takafumi, Takeishi Yasuchika
Department of Cardiovascular Medicine Fukushima Medical University Fukushima Japan.
Department of Advanced Cardiac Therapeutics Fukushima Medical University Fukushima Japan.
J Arrhythm. 2020 Jul 7;36(5):874-882. doi: 10.1002/joa3.12386. eCollection 2020 Oct.
To investigate the clinical implication of the temporal difference in atrial fibrillation (AF)-onset in acute decompensated heart failure (ADHF) and its impact on post-discharge prognosis.
336 new-onset ADHF patients without any history of AF before admission were enrolled (201 males, 63 ± 16 year-old) and classified into two groups based on their history of AF: the Control group (No AF was detected during hospitalization, n = 278), and the In-hos-AF group (AF occurred during hospitalization, n = 58). Post discharge prognosis including rehospitalization due to worsening HF, cardiac death, all-cause death and cerebrovascular event were compared.
Kaplan-Meier analysis demonstrated that the incidence of rehospitalization due to HF, cardiac death, all-cause death and cerebrovascular event in the In-hos-AF group was not significantly different from that in the Control group ( > 0.05 respectively). However, when AF recurred in the In-hos-AF group patients (n = 24, 41%) after discharge, the incidence of rehospitalization due to HF and cardiac deaths were higher than those without AF recurrence ( = 0.018 and = 0.027 respectively). Cox proportional analysis revealed that AF developing after discharge was proven to be an independent risk factor for rehospitalization due to HF (HR 1.845, = 0.043), cardiac death (HR 3.562, = 0.013) and all-cause deaths (HR 2.138, = 0.020).
Clinical outcomes of new-onset in-hospital AF patients were as good as those without AF history until AF recurrence. However, AF recurrence led to worse prognosis. Therefore, treatment for new-onset in-hospital AF in ADHF patients might be postponed until AF recurrence.
探讨急性失代偿性心力衰竭（ADHF）患者房颤（AF）发作时间差异的临床意义及其对出院后预后的影响。
纳入336例入院前无房颤病史的新发ADHF患者（201例男性，63±16岁），根据房颤病史分为两组：对照组（住院期间未检测到房颤，n = 278）和住院期间房颤组（住院期间发生房颤，n = 58）。比较出院后预后，包括因心力衰竭恶化再次住院、心源性死亡、全因死亡和脑血管事件。
Kaplan-Meier分析表明，住院期间房颤组因心力衰竭再次住院、心源性死亡、全因死亡和脑血管事件的发生率与对照组无显著差异（分别>0.05）。然而，住院期间房颤组患者出院后房颤复发（n = 24，41%）时，因心力衰竭再次住院和心源性死亡的发生率高于未复发房颤的患者（分别为=0.018和=0.027）。Cox比例分析显示，出院后发生房颤被证明是因心力衰竭再次住院（HR 1.845，=0.043）、心源性死亡（HR 3.562，=0.013）和全因死亡（HR 2.138，=0.020）的独立危险因素。
新发院内房颤患者在房颤复发前的临床结局与无房颤病史的患者一样好。然而，房颤复发导致预后更差。因此，ADHF患者新发院内房颤的治疗可能推迟至房颤复发时。
