Presentation (CTI)

OBJECTIVES: Therapeutic failure, defined as either transfer to the intensive care unit (ICU) or in-hospital mortality, was assessed among patients with pre-existing atrial fibrillation (AF) admitted to a step-down unit (SDU). Several clinical factors were identified as potential contributors and may influence the likelihood of therapeutic failure in intermediate care, including hypertension, cardiogenic and septic shock, mitral valve disease, acute coronary syndromes, and the use of oral anticoagulants or antiplatelet agents. This study aimed to evaluate the association between NVAF types and therapeutic failure in hospitalized patients admitted to the step-down unit.
METHODS: This retrospective cohort study, which is a secondary analysis, analyzed electronic medical records from the AFICILL 1.0 primary database of patients admitted to the internal medicine department of the Azienda Ospedaliero-Universitaria. Logistic regression analysis examined the association between NVAF type and therapeutic failure, with subgroup analysis adjusting for age and gender.
RESULTS: NVAF had an odds ratio (OR)=1.605, 95% confidence interval (CI) (1.007-2.557), p-value=0.02, favoring permanent NVAF type. After adjusting for age and gender, the OR=1.40, 95% CI (0.87-2.24) and (p-value=0.314) for permanent NVAF type, OR=1.44, 95% CI (1.07-1.92), (p-value=0.02) for males and OR=1.06, 95% CI (1.04-1.07), (p-value<0.001) for every unit increase in age.
CONCLUSIONS: Permanent NVAF type, in AF patients admitted to a step-down unit, initially appeared to be associated with higher risk of death/ICU transfer. After adjusting for age and gender, the association between Permanent NVAF type and adverse outcomes was substantially attenuated and no longer statistically significant, warranting further studies can be conducted to examine the association between NVAF and the outcome. While male gender was independently associated with 44% higher odds of adverse outcomes compared to females, even after adjusting for age and NVAF type.