© 2004 European Society of Cardiology
Impact of atrial fibrillation on mortality and readmission in older adults hospitalized with heart failure
a Division of Gerontology and Geriatric Medicine, Department of Medicine, School of Medicine, Department of Epidemiology and International Health, School of Public Health, Center for Aging and Geriatric Heart Failure Clinic, University of Alabama at Birmingham (UAB), Section of Geriatrics and Geriatric Heart Failure Clinic, Veteran Affairs Medical Center (VAMC), and Heart Failure Project, Alabama Quality Assurance Foundation (AQAF) 1530 3rd Ave South, CH-19, Ste-219, Birmingham, AL, USA
b Department of Pharmacy Practice, Harrison School of Pharmacy, Auburn University, Auburn, and Division of Gerontology and Geriatric Medicine, Department of Medicine, School of Medicine, and Geriatric Heart Failure Clinic UAB, Birmingham, AL, USA
c Section of Cardiology and Heart Failure Clinic, BVAMC, and Division of Cardiovascular Medicine, Department of Medicine, Schools of Medicine UAB, Birmingham, AL, USA
d Birmingham/Atlanta Geriatric Research Education and Clinical Center, Department of Veterans Affairs, Division of Gerontology and Geriatric Medicine, Department of Medicine and Center for Aging, UAB and AQAF Birmingham, AL, USA
e Birmingham AL, USA
* Corresponding author. Tel.: +1-205-934-9632; fax: +1-205-975-7099. E-mail address: aahmed{at}uab.edu
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Abstract |
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Background: Atrial fibrillation is common in older adults with heart failure. It is known to adversely affect outcomes.
Aim: To examine the associations of atrial fibrillation with 4-year mortality and 30-day readmission in older adults hospitalized with heart failure.
Methods: Patients were Medicare beneficiaries 65 years of age and older discharged with a primary diagnosis of heart failure. Baseline data were obtained by retrospective chart reviews and data on mortality and readmission were obtained from Medicare administrative files. Presence of atrial fibrillation was confirmed using electrocardiogram during hospital admission. Using Cox proportional hazards models we estimated bivariate and multivariable (adjusted for various patient and care covariates) hazards ratios (HR) and 95% confidence intervals (CI) for 4-year mortality and 30-day readmission of patients with atrial fibrillation compared with those without.
Results: Patients (n=944) had a mean age (±S.D.) of 79 (±7) years, 61% were women, 18% African–Americans, 25% had atrial fibrillation by admission electrocardiogram, 64% died within 4 years, and 8% were readmitted. Patients with atrial fibrillation had a 52% increased risk of 4-year mortality (adjusted HR=1.52; 95%CI=1.11–2.07). Atrial fibrillation was also associated with higher risk of readmission (unadjusted HR=1.64; 95%CI=1.01–2.68). However, the association lost its statistical significance after adjustment for various patient and care variables (adjusted HR=2.09; 95%CI=0.94–4.65).
Conclusion: Presence of atrial fibrillation was associated with significant increased risk of long-term mortality in older adults hospitalized with heart failure and was associated with a non-significant higher risk of hospital readmission.
Key Words: Atrial fibrillation • Electrocardiogram • Heart failure
Received June 4, 2003; Revised October 9, 2003; Accepted November 25, 2003
CMS Disclaimer: The analyses upon which this publication is based were performed under Contract Number 500-02-AL02, entitled ‘Utilization and Quality Control Peer Review Organization for the State (Commonwealth) of Alabama,’ sponsored by the Centers for Medicare and Medicaid Services (CMS, formerly HCFA), Department of Health and Human Services (DHHS). The content of this publication does not necessarily reflect the views or policies of the DHHS, nor does mention of trade names, commercial products, or organizations imply endorsement by the US Government. The authors assume full responsibility for the accuracy and completeness of the ideas presented. This article is a direct result of the Health Care Quality Improvement Program initiated by the CMS, which has encouraged identification of quality improvement projects derived from analysis of patterns of care, and therefore required no special funding on the part of this contractor. Ideas and contributions to the author concerning experience in engaging with issues presented are welcomed.
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