Admission with heart failure or atrial fibrillation before mitral valve surgery and associated outcomes

BACKGROUND: In patients with mitral regurgitation (MR), atrial fibrillation (AF), or heart failure (HF), are common indications for mitral valve surgery (MVS). However, whether first-time admissions for AF and HF are associated with similar prognostic impact remains unclear.

AIM: To evaluate the risk of mortality after MVS among patients with recent hospitalization for AF or HF.

METHODS: Using Danish nationwide registries (2000-2023), we identified patients undergoing first-time MVS for MR. Based on admissions within 6 months before surgery, patients were categorized as: (1) no new AF/HF (no first-time admission for AF or HF), (2) AF group (first-time admission for AF but not HF), or (3) HF group (first-time admission for HF, irrespective of admission for AF). We examined the 1-year rate of HF admission from discharge using multivariable Cox regression. From the date of MVS, we examined the rate of mortality.

RESULTS: Compared with patients with no new AF/HF, the adjusted rate of admission for HF was significantly higher in the AF group (hazard ratio [HR] 1.55; 95% CI: 1.19-2.02) and the HF group (HR 1.67; 95% CI: 1.33-2.11). When examining mortality, we observed a higher 30-day risk among patients in the HF group, and no difference between groups beyond 30 days of follow-up.

CONCLUSION: In patients undergoing MVS for MR, first-time admission for AF or HF within 6 months before MVS was associated with increased risk of admission for HF after MVS. Mortality appeared higher in the HF group during the initial 30 days postsurgery.