AF was associated with significantly worse in-hospital outcomes among adults admitted with HE. The analysis, reported in Circulation, evaluated how the presence of atrial fibrillation influences clinical outcomes in this acute presentation.

A cross-sectional analysis of the 2018–2021 National Inpatient Sample identified 1,009,540 hospitalizations for HE. Of these, 869,460 (86.2%) had atrial fibrillation. Patients with AF were older and had higher rates of congestive heart failure. Multivariate logistic regression assessed differences in mortality, cardiovascular complications, and resource utilization.

Outcome comparison showed increased odds of in-hospital mortality in the AF group (adjusted odds ratio [aOR] 1.53, 95% CI 1.43–1.63). Stroke (aOR 1.45, 95% CI 1.34–1.57), cardiogenic shock (aOR 1.75, 95% CI 1.53–2.01), and need for mechanical ventilation (aOR 1.37, 95% CI 1.31–1.43) were also more likely. Rates of myocardial infarction, acute heart failure, and dialysis did not differ significantly between groups.

These findings reinforce that atrial fibrillation substantially increases clinical risk in HE and highlight the need for structured risk stratification and targeted inpatient management.