Tamimi Omar, Tamimi Faisal, Gorthi Janardhana
Department of Medicine, Houston Methodist Hospital, Houston, TX.
Department of Medicine, Jamaica Medical Center, Queens, NY.
Curr Probl Cardiol. 2024 Jan;49(1 Pt A):102014. doi: 10.1016/j.cpcardiol.2023.102014. Epub 2023 Aug 6.
The aim of our retrospective study is to determine the influence of co-morbid atrial fibrillation or flutter (AF) on decompensated congestive heart failure (CHF) admissions using data from the 2020 nationwide inpatient sample. We identified 76,835 adults admitted nonelectively with decompensated CHF. After multivariate adjustment, we found decompensated heart failure with reduced ejection fraction (HFrEF) admissions with AF had 37% higher odds of in-hospital mortality, (OR 1.38 [95% CI 1.1-1.72] P < 0.01), 33% higher odds for mechanical ventilation (MV) (OR 1.33 [95% CI 1.14-1.55] P < 0.01), 39% higher odds of early MV (OR 1.39 [95% CI 1.16-1.66] P < 0.01), 54% higher odds of cardiogenic shock (OR 1.54 [95% CI 1.29-1.84] P < 0.01), 61% increased odds of mechanical circulatory support (MCS) requirement (OR 1.61 [95% CI 1.12-2.31] P < 0.02), significantly higher odds of acute renal failure (AKI) necessitating dialysis (OR 2.20 [95% CI 1.39-2.48] P < 0.01), 1-day increase in mean length of stay (LOS) (6.7 vs 5.7 days, adjusted difference: 0.99, P < 0.01), $13,281 increase in total hospitalization charges ($84,316 vs $74,279, adjusted difference: $13,281, P < 0.05) compared to the non-AF cohort. Moreover, we found decompensated heart failure with preserved ejection fraction (HFpEF) admissions with AF had a 23% increased odds of MV (OR 1.23 [95% CI 1.01-1.50] P < 0.01), 24% higher odds of early MV (OR 1.24 [95% CI 1.00-1.53] P < 0.01), 0.36 days increase in mean LOS (5.5 vs 5.2 days, adjusted difference: 0.36, P = < 0.01), but no significant difference in in-hospital mortality (OR 1.23 [95% CI 0.86-1.75] P = 0.25), cardiogenic shock (OR 1.75 [95% CI 0.96-3.19] P < 0.07), dialysis-dependent AKI (OR 0.46 [95% CI 0.18-1.17] P < 0.10), or mean total hospitalization charges ($52,086 vs $47,990, adjusted difference: $5584, P = 0.06) compared to the non-AF cohort.
我们这项回顾性研究的目的是利用2020年全国住院患者样本数据，确定合并存在的心房颤动或心房扑动（AF）对失代偿性充血性心力衰竭（CHF）住院治疗的影响。我们确定了76835例非选择性收治的失代偿性CHF成年患者。经过多变量调整后，我们发现，伴有AF的射血分数降低的失代偿性心力衰竭（HFrEF）患者住院死亡率的比值比高37%（比值比1.38 [95%置信区间1.1 - 1.72]，P < 0.01），机械通气（MV）的比值比高33%（比值比1.33 [95%置信区间1.14 - 1.55]，P < 0.01），早期MV的比值比高39%（比值比1.39 [95%置信区间1.16 - 1.66]，P < 0.01），心源性休克的比值比高54%（比值比1.54 [95%置信区间1.29 - 1.84]，P < 0.01），需要机械循环支持（MCS）的比值比增加61%（比值比1.61 [95%置信区间1.12 - 2.31]，P < 0.02），因急性肾衰竭（AKI）需要透析的比值比显著更高（比值比2.20 [95%置信区间1.39 - 2.48]，P < 0.01），平均住院时间（LOS）增加1天（6.7天对5.7天，调整后差异：0.99，P < 0.01），与非AF队列相比，总住院费用增加13281美元（84316美元对74279美元，调整后差异：13281美元，P < 0.05）。此外，我们发现，伴有AF的射血分数保留的失代偿性心力衰竭（HFpEF）患者MV的比值比增加23%（比值比1.23 [95%置信区间1.01 - 1.50]，P < 0.01），早期MV的比值比高24%（比值比1.24 [95%置信区间1.00 - 1.53]，P < 0.01），平均LOS增加0.36天（5.5天对5.2天，调整后差异：0.36，P < 0.01）；但与非AF队列相比，在住院死亡率（比值比1.23 [95%置信区间0.86 - 1.
