Abstract 4144552: Difference in Characteristics and Outcomes of Atrial Fibrillation patients based on type of Heart Failure: An NRD Propensity Matched Analysis

Background: Heart Failure(HF) significantly deteriorates outcomes in patients with Atrial Fibrillation. Heart Failure with Preserved Ejection Fraction(HFpEF) and Atrial Fibrillation(AFib) share common disease progression pathways and are gradually increasing in prevalence. Aim: We aim to study the variation in characteristics and outcomes based on type of heart failure in patients with AFib using the National Readmission Database(2016-2020). Methods: NRD database was used to identify patients with Atrial Fibrillation using ICD-10 codes. Patients were stratified into two groups based on the presence of systolic dysfunction and diastolic dysfunction. Patients with combined systolic and diastolic dysfunction were excluded. Information was collected on patient demographics, comorbidities, and outcomes. Propensity score matching was performed to compare outcomes among AFib patients with HFrEF and HFpEF. Results: A total of 6,673,080 patients with AFib and isolated systolic or isolated diastolic dysfunction were included in the analysis. 3,914,695(58.66%) had HFpEF and 2,758,385 (41.34%%) had HFrEF. In the HFpEF group 57.8% were females in comparison with 33.12% females in the HFrEF group. HFpEF group had a higher rate of hypertension (84.9% vs 82%, p<0.001), OSA(19.35 vs 14.9, p<0.001), immunocompromised status (0.06 vs 0.04%, p<0.001), hypothyroidism(23.7% vs 18.47%,P<0.001), Anemia(10.1% vs 7.95%, p<0.001), Pneumonia (13.51%) and Pulmonary disease(37.34% vs 30.98%) as compared to the HFrEF group. In the propensity matched analysis, HFpEF group had lower in-hospital death (5.26% vs 6.59%, p<0.001), acute kidney injury (33.19% vs 38.92%; p<0.001), stroke (0.99% vs 1.71%), cardiogenic shock (1.02% vs 3.29%; p<0.001), Myocardial infarction (3.60% vs 7.65%; p<0.001), sudden cardiac arrest (1.95% vs 2.62%;p<0.001), mechanical circulatory device use(0.16% vs 0.77%;p<0.001) and major adverse cardiovascular event(9.79% vs 16.06%;p<0.001). Discussion: In Afib patients with HFpEF, yearly admissions were higher in comparison to the HFrEF group. Furthermore, we found a higher prevalence of hypertension, obesity, OSA, pulmonary disease, pneumonia, immunocompromised status, hypothyroidism, and anemia in comparison with the HFrEF group. However, mortality rate in HFpEF group and MACE were lower. At present, there are no definite therapies for patients with HFpEF that have displayed a clear mortality benefit highlighting the need for further inquiry.