Exploring the Link between eGFR and All-Cause Mortality in Atrial Fibrillation Patients with Heart Failure: Insights from the MIMIC-IV Database

Aim Atrial fibrillation (AF) and heart failure (HF) are prevalent cardiovascular conditions. The estimated glomerular filtration rate (eGFR) is a crucial marker for assessing kidney function and has demonstrated prognostic significance in various cardiovascular diseases. However, its specific impact on patients with both AF and HF remains unclear.
Material and methods This retrospective cohort study utilized data from the MIMIC–IV database, focusing on a subset of ICU patients diagnosed with both atrial fibrillation (AF) and heart failure (HF). Patients were categorized based on eGFR levels, and the association between eGFR and all-cause ICU mortality, as well as 28‑day post-discharge mortality, was analyzed using the Cox proportional hazards model.
Results Analysis revealed significant differences (p<0.001) in age, ICU length of stay, and prevalence of chronic diseases across different eGFR groups. As eGFR increased, the risk of death (HR) significantly decreased. The group with the lowest eGFR (first quartile, Q1) had the highest mortality risk, whereas the highest eGFR group (Q4) showed a protective effect (HR=1.14, P=0.019). There was a significant non-linear relationship between eGFR and all-cause mortality (p<0.001). Lower eGFR levels substantially increased mortality risk, highlighting eGFR as a key prognostic indicator for AF patients with HF. Survival probability and mortality risk varied significantly among different eGFR levels (HR=0.54, 95 % CI: 0.48– 0.60, p<0.001). These findings underscore the importance of monitoring and intervening in renal function.
Conclusion Lower eGFR levels are independently linked to higher all-cause mortality in patients with AF and HF.

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