| Background-Heart failure(HF)and atrial fibrillation(AF)are two closely intertwined cardiovascular diseases,which are the main causes of the incidence of cardiovascular diseases and the mortality of the elderly in China.With the aging of the population in the world and China,the two cardiovascular diseases have been perplexing millions of patients.From previous studies,heart failure and atrial fibrillation affect each other,there are the same cardiovascular risk factors,such as various heart valvular disease,hypertension,coronary heart disease,diabetes and so on.After the analysis of some real-world heart failure trials and other cohort trials,it is controversial whether atrial fibrillation is an independent predictor of long-term prognosis of heart failure.In particular,little is known about the impact of atrial fibrillation on the specific long-term outcome of hospitalized patients with heart failure,and it is not clear whether atrial fibrillation is related to the poor prognosis of hospitalized patients with heart failure.Objectives-Through retrospective analysis of large samples,heart failure patients with atrial fibrillation were selected to study and analyze their clinical features,long-term hospitalization rate and mortality,and to explore whether AF is an independent risk factor for the prognosis of HF.The purpose of this study is to provide clinical reference for the treatment and prognosis of HF patients with AF in practice.Methods-NYHA Ⅱ-Ⅳ patients diagnosed with heart failure in Hebei Provincial people’s Hospital from January 1,2017 to June 30,2018 were retrospectively collected.They were divided into heart failure sinus rhythm group and heart failure atrial fibrillation group according to the presence or absence of atrial fibrillation.The general admission condition,clinical basic features,admission laboratory examination and imaging results,and drug treatment regimens were collected and compared.All patients were followed up to June 30,2019,mainly by telephone,outpatient service or case system to observe the occurrence of long-term rehospitalization,stroke and death.Through the data statistics of SPSS24.0,we found the independent risk factors of patients with heart failure and atrial fibrillation,and compared the difference of long-term readmission rate and mortality between the two groups.Results-A total of 733 patients were included in this study,including sinus rhythm group(n = 435)and atrial fibrillation group(n = 298).Through multivariate logistic regression analysis,with the sinus rhythm group as the control group,it was found that with the increase of age,left atrial diameter and pulmonary artery pressure,the decrease of hemoglobin and left ventricular end-systolic diameter were the independent risk factors in the heart failure and atrial fibrillation group(P < 0.05).In terms of etiology,the number of rheumatic heart disease patients in the atrial fibrillation heart failure group was more than that in the sinus rhythm group.From the perspective of long-term end events,all-cause mortality was higher in atrial fibrillation group(P < 0.021),and there was no significant difference in rehospitalization rate and stroke(P > 0.05).After COX multivariate analysis,it was found that atrial fibrillation was an independent risk factor for the death outcome of hospitalized patients with heart failure(HR=3.23,95%CI:1.537-6.790).Conclusions-With the increase of age,left atrial diameter and pulmonary artery pressure,the decrease of hemoglobin and left ventricular end-systolic diameter were independent risk factors for atrial fibrillation in patients with heart failure.Patients with rheumatic heart disease were independent risk factors for heart failure complicated with atrial fibrillation.During hospitalization and long-term treatment,the utilization rate of ACEI/ARB in atrial fibrillation group was lower,and the patients with heart failure complicated with atrial fibrillation performed better in medication compliance and outpatient follow-up.There was no significant difference in re-hospitalization rate and stroke incidence within one year,but the risk of death in all-cause heart rhythm group was significantly higher than that in sinus rhythm group.It is suggested that atrial fibrillation is an independent risk factor for cardiovascular death in hospitalized patients with heart failure. |
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