The impact of arrhythmias in acute heart failure.
BACKGROUND
Arrhythmias are common in chronic heart failure and affect outcomes. The incidence and significance of new arrhythmias in acute heart failure, however, are largely unknown.


RESULTS
The Outcomes of a Prospective Trial of Intravenous Milrinone for Exacerbations study randomized 949 patients with decompensated heart failure to receive intravenous milrinone or placebo. In the study, patients were divided into 2 groups based on the occurrence of a new arrhythmic event during their index hospitalization and analyzed for outcome. There were 59 new arrhythmic events occurring in 6% of the population. Of these, 49% were atrial fibrillation/flutter. The primary endpoint of days hospitalized for cardiovascular causes within 60 days after randomization was 30.9+/-22.7 for those in the arrhythmia group and 11.3+/-12.7 days for those with no arrhythmias (P=.0001). Mortality during index hospitalization was 26% in the arrhythmia group and 1.8% in the no arrhythmia group (P=.001). Death or hospitalization at 60 days was also worse in the arrhythmia group (35 versus 8.2%, P=.0001; 57 versus 34%, P=.001, respectively). Cox proportional hazard analysis identified new arrhythmias as an independent risk factor for the primary endpoint and death at 60 days.


CONCLUSIONS
New arrhythmia during an exacerbation of heart failure identifies a high-risk group with higher intrahospital and 60-day morbidity and mortality.
Benza
Raymond L
RL
University of Alabama at Birmingham, Birmingham, Alabama 35294, USA.
Tallaj
José A
JA
Felker
G Michael
GM
Zabel
K Michael
KM
Kao
Walter
W
Bourge
Robert C
RC
Pearce
Douglas
D
Leimberger
Jeffrey D
JD
Borzak
Steven
S
O'connor
Christopher M
CM
Gheorghiade
Mihai
M
D000208:Acute Disease; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000188:drug therapy / Q000453:epidemiology*; D001281:Atrial Fibrillation / Q000188:drug therapy / Q000453:epidemiology; D002316:Cardiotonic Agents / Q000627:therapeutic use; D023381:Endpoint Determination; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000188:drug therapy / Q000453:epidemiology*; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D017180:Tachycardia, Ventricular / Q000188:drug therapy / Q000453:epidemiology; D014693:Ventricular Fibrillation / Q000188:drug therapy / Q000453:epidemiology
D002316:Cardiotonic Agents