Prevalence and Influence of Atrial Fibrillation on Short-term Outcomes of Nonagenarians Undergoing Surgical Intervention for Hip Fractures

Vladimir Zeldetz 1 Yigal Plakht 2 Yuri Goldberg 3 Boris Punchik 4,5 Yan Press 4,5 ARYEH SHALEV 6,7
1Emergency Medicine, Soroka University Medical Center, Be'er Sheva
2Nursing Research Unit, Soroka University Medical Center, Ben Gurion University of The Negev, Be'er Sheva
3Cardiology Services, Clalit Health Services - Southern Region, Be'er Sheva
4Comprehensive Geriatric Assessment Unit, Clalit Health Services - Yassky Clinic, Be'er Sheva
5Sial Center for Research in Family Medicine, Faculty of Health Sciences, Ben Gurion University of The Negev, Be'er Sheva
6Cardiology, Soroka University Medical Center, Be'er Sheva
7Faculty of Health Sciences, The Joyce & Irving Goldman Medical School, Ben Gurion University of The Negev, Be'er Sheva

Background: The impact of atrial fibrillation (AF) on the short-term outcomes of nonagenarians undergoing surgery for hip fracture has been poorly studied. We sought to determine whether AF is associated with increased mortality in this group of patients.

Methods: A retrospective cohort of 88 consecutive patients ≥90 years-old that underwent surgery for hip fracture between 2013-2014. Patients were divided into two groups: sinus rhythm (SR) vs. AF. Charlson comorbidity index (CCI) was calculated. Occurrence of major bleeding (transfusion of at least two units of red blood cells or drop in hemoglobin >2gr/L) or thrombotic event (stroke, acute coronary syndrome, deep vein thrombosis, pulmonary embolism) were recorded. Mortality data was retrieved from Clalit Health Service database. The main outcome measures were crude and adjusted survival rates at 30 and 180 days, and were evaluated by Cox-regression models.

Results: 78% of patients were female. 29 patients had AF, of which 55% were male. There were no significant differences in major bleeding or thrombotic events between SR and AF patients during 30-days follow-up (78% vs. 76%, p=0.82 for bleeding, and 13% vs. 3%, p=0.26 for thrombosis). All cause mortality at 30-day was significantly higher in AF patients in comparison to SR patients (Hazard ratio – 2.98, CI 1.003-0.86, p=0.033), but not at 180-day follow-up. In multivariable analysis AF was an independent predictor of 30-days mortality (Hazard ratio -3.6, CI 1.046-12.39, p=0.04).

Conclusions: Atrial fibrillation is an independent predictor of increased short-term mortality in nonagenarians undergoing surgery for hip fracture.









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