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Background and Aim: The increasing prevalence and high hospitalization rates make atrial fibrillation (AF) a significant healthcare strain. However, there are limited data regarding the length of hospital stay (LOS) of AF patients. Our purpose was to determine the main drivers of extended LOS of AF patients. Methods: All AF patients, hospitalized consecutively in a tertiary cardiology center, from January 2018 to February 2020 were included in this retrospective cohort study. Readmissions were excluded. Prolonged LOS was defined as more than seven days (the upper limit of the third quartile). Results: Our study included 949 AF patients, 52.9% females. The mean age was 72.5 ± 10.3 years. The median LOS was 4 days. A total of 28.7% had an extended LOS. Further, 82.9% patients had heart failure (HF). In multivariable analysis, the independent predictors of extended LOS were: acute coronary syndromes (ACS) (HR 4.60, 95% CI 1.66–12.69), infections (HR 2.61, 95% CI 1.44–3.23), NT-proBNP > 1986 ng/mL (HR 1.96, 95% CI 1.37–2.82), acute decompensated HF (ADHF) (HR 1.76, 95% CI 1.23–2.51), HF with reduced ejection fraction (HFrEF) (HR 1.69, 95% CI 1.15–2.47) and the HAS-BLED score (HR 1.42, 95% CI 1.14–1.78). Conclusion: ACS, ADHF, HFrEF, increased NT-proBNP levels, infections and elevated HAS-BLED were independent predictors of extended LOS, while specific clinical or therapeutical AF characteristics were not.

Introduction. At the crossroads of heart failure (HF) and systemic inflammation, platelets and lymphocytes are both influenced as well as actively participating in the bidirectional relationship. The platelet to lymphocyte ratio (PLR) could therefore be a marker of severity. This review aimed to assess the role of PLR in HF. Methods. We searched the PubMed (MEDLINE) database using the keywords “platelet”, “thrombocyte”, “lymphocyte”, “heart failure”, “cardiomyopathy”, “implantable cardioverter defibrillator”, “cardiac resynchronization therapy” and “heart transplant”. Results. We identified 320 records. 21 studies were included in this review, with a total of 17,060 patients. PLR was associated with age, HF severity, and comorbidity burden. Most studies reported the predictive power for all-cause mortality. Higher PLR was associated with in-hospital and short-term mortality in univariable analysis, however, it was not consistently an independent predictor for this outcome. PLR > 272.9 associated an adjusted HR of 3.22 (95%CI 1.56 – 5.68, p<0.001) for 30-day fatality. During long-term follow-up from 6 months to 5 years, PLR was an independent predictor of mortality in most studies, with cut-off values ranging from > 150 to > 194.97 and adjusted HR from 1.47 (95%CI 1.06 – 2.03, p=0.019) to 5.65 (95%CI 2.47–12.96, p<0.001). PLR > 173.09 had an adjusted OR 2.89 (95%CI 1.17–7.09, p=0.021) for predicting response to cardiac resynchronization therapy. PLR was not associated with outcomes after cardiac transplant or implantable cardioverter-defibrillator. Conclusion: Increased PLR could be an auxiliary biomarker of severity and survival prognosis in HF patients.

Introduction Heart failure (HF) affects platelet activation, function, as well as the production of platelets from megakaryocytes. Low platelet counts have been described in HF patients, however without clear distinction whether this is a consequence of HF severity or an independent comorbidity contributing to worse outcomes. Aim Our purpose was to assess the prognostic role of thrombocytopenia in HF patients. Methods Patients with HF admitted to our Cardiology Department were included in this study, after excluding acute coronary syndromes, pulmonary embolisms, infections, malignancy and hepatic cirrhosis. Thrombocytopenia was defined as a platelet number below 15ehz747.0353/uL and classified as severe below 5ehz747.0353/uL and moderate between 5ehz747.0353–1ehz747.03530/uL. Patients with a left ventricular ejection fraction (LVEF) <40% were classified as HF with reduced EF (HFrEF), those with a LVEF between 40 and 49% as HF with mid-range EF (HFmrEF) and the rest as HF with preserved EF (HFpEF). All-cause mortality was assessed after a mean follow-up of 5.5 years. Results We included 1142 patients, with a mean age of 72.45±10.53 and 51.6% female. 121 (10.6%) patients had thrombocytopenia, of which 3 had severe thrombocytopenia and 21 had moderate thrombocytopenia. All-cause long-term mortality was 43.8%. Patients with acute decompensated heart failure had similar prevalence of thrombocytopenia as those with stable heart failure (12.3% vs 9.5%, p=0.22). Patients with thrombocytopenia had a higher risk ratio for all-cause mortality compared to patients with normal platelet counts (RR 1.35, 95% CI 1.14–1.60, p=0.002). Patients with severe thrombocytopenia had a risk ratio of 2.29 (95% CI 2.14–2.45, p=0.049), those with moderate thrombocytopenia had a risk ratio of 1.80 (95% CI 1.39–2.33, p=0.006) and those with mild thrombocytopenia had a risk ratio of 1.23 (95% CI 1.01–1.51, p=0.06) of all-cause long-term mortality, compared to patients with normal platelet counts. Patients with thrombocytopenia and HFpEF (RR 1.66, 95% CI 1.16–2.37, p=0.021) or HFrEF (RR 1.35, 95% CI 1.09–1.68, p=0.03) had higher risk of all-cause long-term mortality, but not those with HFmrEF and thrombocytopenia (RR 1.09, 95% CI 0.67–1.76, p=0.73), possibly due to the predominance of mild thrombocytopenia (80.9%). In multiple regression analysis, after adjusting for age and sex, alongside NT-proBNP levels and left ventricular ejection fraction, moderate thrombocytopenia (p=0.031) was an independent predictor of all-cause long-term mortality, but not mild thrombocytopenia (p=0.415). Due to the very low number of patients, no multiple regression analysis could be computed with severe thrombocytopenia. Conclusions Thrombocytopenia is an independent predictor of mortality in HF patients, especially platelet counts below 1ehz747.03530/uL. In both patients with HFrEF and HFpEF this biomarker should be assessed for prognosis.