Düşük Ejeksiyon Fraksiyonlu Kalp Yetersizliği Hastalarında Hastane İçi Mortaliteyi Artıran Bağımsız Bir Belirteç Olarak Yeni Başlangıçlı Atriyal Fibrilasyon

Amaç: Kalp yetersizliği yüksek mortalite ile ilişkili olup, atriyal fibrilasyon (AF) düşük ejeksiyon fraksiyonlu kalp yetersizliği (HFrEF) hastalarında en sık görülen aritmidir. Çalışmamızda, bu hastalarda yeni başlangıçlı AF’nin bağımsız prognostik bir belirteç olup olmadığını araştırdık. Ayrıca, çalışmamızda HFrEF hastalarında hastane içi mortaliteyi etkileyen diğer parametreler de değerlendirildi. Gereç ve Yöntem: Çalışmamız retrospektif, gözlemsel bir çalışmadır. Dekompanse kalp yetersizliği nedeniyle hastanemize kabul edilen sinüs ritmindeki 119 düşük ejeksiyon fraksiyonlu (EF) hasta yatış özellikleri, hastane içi olaylar ve mortalite açısından değerlendirilmiştir. Bulgular: Hastaların %12’si hastane izlemi sırasında kaybedilmiştir. Hastaların ortalama yaşı 71±9 olup %37’si kadındır. Ortalama EF’si 27±7 olup ortalama hastanede yatış süresi 9±4 gündü. Düşük vücut kitle indeksi, düşük glomerüler filtrasyon hızı ve uzun hastane yatışı olan hastalar daha fazla hastane içi mortaliteye sahipti (sırasıyla; p=0,02, p=0,04 ve p= 0,001). Yeni başlangıçlı AF, restriktif doluş bozukluğu ve anjiyotensin enzim/ reseptör inhibitörleri kullanmamak da yüksek hastane içi mortalite ile anlamlı olarak ilişkiliydi (sırasıyla; p=0,001, p=0,001 ve p=0,02). Uzun hastane yatışı ve yeni başlangıçlı AF hastane içi mortalite için bağımsız belirleyiciler olarak saptandı [sırasıyla p=0,006 Odds oranı (OR): 1,394 (1,0988-1,771] ve p=0,012 OR: 10,869 (2,677-71,428)]. Sonuç: Hastaneye dekompanse olarak kabul edilen HFrEF hastalarında prognoz kötüdür. Çalışmamızda yeni başlangıçlı AF ve uzamış hastane yatışının mortalite üzerine bağımsız olarak etki eden belirteçler olduğunu saptadık. Hastane içi ölümlere etki eden prognostik belirteçleri iyi saptayabilmek, bu hastalarda daha yoğun ve etkin hedefler için yardımcı olabilir.

New-onset Atrial Fibrillation: An Independent Predictor of in-hospital Mortality in Reduced Ejection Fraction Heart Failure Patients

Objectives: Heart failure (HF) is associated with high mortality and atrial fibrillation (AF) is the most common arrhythmia encountered in HFpatients with reduced ejection fraction (EF). We aimed to assess whether new-onset AF is an independent poor prognostic factor in this group ofpatients. We also searched for parameters that might influence the in-hospital mortality in reduced EF heart failure (HFrEF) patients.Materials and Methods: The study was a retrospective observational study investigating the admission characteristics and in-hospital events for119 HFrEF patients at sinus rhytym, admitted for decompensated heart failure. We evaluated the in-hospital mortality and aimed to identify thepredictive factors.Results: Overall 12% of the heart failure patients died during hospitalization. The mean age of the study population was 71±9 years with 37% female.The mean EF was 27±7% and mean duration of hospitalization was 9±4 days. Patients with lower body mass index, lower glomerular filtration rateand patients with longer hospitalization had significantly higher in-hospital mortality rates (p=0.02, p=0.04 and p=0.001, respectively). New-onset AF,restrictive filling pattern and being angiotensin-converting enzyme inhibitors/angiotensin receptor blockers naive were factors significantly relatedto higher mortality (p=0.001, p=0.001 and p=0.02, respectively). Long hospitalization duration and new-onset AF at hospital were independentpredictors of in-hospital mortality [p=0.006 Odds ratio (OR): 1.394 (1.098-1.771) and p=0.012 OR: 10.869 (2.677-71.428), respectively].Conclusion: In hospital outcome of patients admitted with decompensated HFrEF is poor. In our trial, patients with new-onset AF and patients withlonger hospitalization duration had higher mortality rates. An understanding of the risk factors for in-hospital deaths may help improving intensivecare for this patient population.

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