Abstract P7: The Impact of Cardiovascular Hospitalization on Mortality and Quality of Life Among 14,261 Atrial Fibrillation Patients in the ACTIVE Study

Background Cardiovascular (CV) hospitalization has been used as primary outcome in atrial fibrillation (AF) research, but remains controversial. Our aim was to provide detailed information on characteristics and impact of CV hospitalization among 14,261 patients in the ACTIVE clinical trial. Methods Patient characteristics, mortality and time to first non-fatal CV hospitalization were measured in the ACTIVE controlled clinical trial setting. Multivariable proportional hazards regression analysis was used to determine factors associated with CV hospitalization, and to assess the independent association of CV hospitalization with all-cause mortality and quality of life using the EuroQoL scale. Results During a median follow-up of 3 years and 11 months, 10,584 CV hospitalizations were observed, of which 9,859 were non-fatal and 725 fatal. Non-fatal CV hospitalization had occurred in 50% of patients after 4 years follow-up and was more likely to occur in patients with at baseline heart failure (relative risk (RR) = 1.32; p<0.0001), coronary artery disease (RR = 1.43; p<0.0001), an antiarrhythmic drug (RR = 1.19; p<0.0001), sinus rhythm (RR = 1.42; p<0.0001) and with a history of fainting (RR = 1.23; p<0.0001), while less likely in working patients (RR = 0.84; p<0.0001). All-cause mortality in patients with at least 1 CV hospitalization was 6.60 per 100 patient years versus 4.97 per 100 patient years in patients without CV hospitalization. In time-dependent analysis, patients with CV hospitalization had an increased risk for mortality (RR = 3.13; p<0.0001), which remained significant when adjusting for baseline risk factors (RR = 3.00; p<0.0001). Heart failure hospitalization had the strongest association with mortality (RR = 5.92; p<0.0001), while hospitalization for AF was not associated (RR = 1.08; p=0.3058). The decrease in the EuroQoL quality of life score during the study was larger in surviving patients with CV hospitalization (−0.03 ± 22) compared with remaining survivors (−0.01 ± 21; p<0.0001). Conclusions Half of ACTIVE study patients had at least one CV hospitalization during 4 years, which was associated with increased mortality and a reduced quality of life in surviving patients. Hospitalization for AF alone was not associated with mortality.