Atrial fibrillation (AFib) increases the likelihood that aortic stenosis (AS) patients will experience in-hospital complications, according to new findings published in the American Journal of Cardiology. This appears to be the case for patients undergoing both transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR).
The study’s authors explored the Nationwide Readmissions Database, identifying adult patients with AS. Patients with endocarditis were excluded from the analysis. The team focused on such complications as mortality, stroke, acute kidney injury (AKI), major bleeding events and pacemaker implantation up to six months after discharge.
Overall, out of nearly 741,000 patients, 40.4% had AFib at the time of hospital admission. While 7% of those patients underwent TAVR, another 9.3% underwent SAVR. The remaining patients did not undergo aortic valve replacement.
In-hospital mortality occurred in 1.7% of AS patients with AFib and 1.1% of AS patients without AFib. AKI and major bleeding events were also more likely among AS patients with AFib than those without AFib. Bleeding events were more common among SAVR patients.
Also, a multivariate regression analysis with several adjustments found a “significant association of the presence of AFib with in-hospital mortality” for patients who underwent TAVR or no aortic valve replacement at all. Such a link was not observed for patients who underwent SAVR.
“Medically optimizing modifiable risk factors like AFib before aortic valve replacement may help lower the rates of in-hospital complications and readmission, thereby also lowering the cost of hospitalization to the patient,” wrote lead author Shashank Shekhar, MD, of Cleveland Clinic’s Heart and Vascular Institute, and colleagues. “This reflects a need for incorporating AF into the decision-making algorithm for aortic valve replacement.”
Read the full analysis here.
Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.