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 six months prior to 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 one-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 six months before MVS were associated with increased risk of admission for HF after MVS. Mortality appeared higher in the HF group during the initial 30 days post-surgery.