Atrial Fibrillation Raises In-Hospital and 1-Year Mortality Risk in Hemodialysis Patients with STEMI, Study Finds
Italy: Researchers have found that atrial fibrillation (AF) significantly worsens survival outcomes in patients undergoing hemodialysis hospitalized with ST-elevation myocardial infarction (STEMI). Published in Kidney Medicine, the retrospective cohort study highlights a concerning link between AF and increased risk of both in-hospital and one-year mortality in this vulnerable patient group.
The study analyzed data from 1,185 patients on maintenance hemodialysis admitted with STEMI between 2003 and 2018. Of these patients, 16.5% either had AF at admission time or developed it during their hospital stay.
Simonetta Genovesi, Istituto Auxologico Italiano, IRCCS, Milan, Italy, and colleagues used a large administrative database, including nearly 139,000 patients admitted with STEMI, but focused on those undergoing hemodialysis. The primary measure was in-hospital mortality, while secondary outcomes included mortality and readmission rates over a year. Statistical analyses were adjusted for multiple clinical and demographic variables to ensure robust findings.
Key Findings:
- After adjusting for confounding factors, atrial fibrillation (AF) was linked to a 57% higher risk of in-hospital death compared to patients with normal heart rhythm.
- Patients with AF had a 45% increased risk of death within one year after discharge.
- AF did not affect the hospital readmission rate for acute myocardial infarction within one year.
- Fewer than 20% of patients with AF who survived hospitalization were prescribed oral anticoagulants (OACs).
- Patients with AF who received OACs had about a 54% lower risk of death within one year compared to those not treated with anticoagulants.
Despite the strong associations reported, the authors acknowledge certain limitations. The study's retrospective nature and potential inaccuracies in medical coding might have influenced the results. Additionally, the study did not capture specific causes of death during the follow-up period or the incidence of thromboembolic events after discharge.
The findings highlight the high prevalence of atrial fibrillation among hemodialysis patients suffering from STEMI and its association with adverse outcomes. The clear survival benefit observed with oral anticoagulant use in this population suggests that early identification and treatment of AF could improve prognosis. Given that anticoagulants were underprescribed, these results emphasize the need for clinicians to evaluate the potential role of OAC therapy carefully in managing such patients.
"The study calls attention to AF as a significant risk factor for mortality in hemodialysis patients admitted with STEMI. The observed reduction in mortality with anticoagulant treatment highlights a promising avenue to improve long-term outcomes," the authors wrote. They recommend further prospective research to better understand optimal management strategies, including the use of oral anticoagulant use, in this high-risk group.
Reference:
Genovesi, S., Regolisti, G., Bonomi, A., Leoni, O., Galotta, A., & Marenzi, G. (2025). Atrial Fibrillation Is Associated With Increased In-hospital and 1-Year Mortality in Patients on Hemodialysis with ST-Elevation Myocardial Infarction: A Retrospective Cohort Study. Kidney Medicine, 101023. https://doi.org/10.1016/j.xkme.2025.101023
