Atrial Fibrillation Among ICU Patients with Type 2 Respiratory Failure: Who Is at Risk and What Are the Outcomes?

Background: Atrial fibrillation (AF) is commonly seen in patients with hypercapnic type 2 respiratory failure and may negatively impact prognosis. This study aimed to evaluate the clinical characteristics and prognostic implications of AF in patients admitted to the intensive care unit (ICU) with hypercapnic type 2 respiratory failure. Methods: In this retrospective single-center study, 200 adult patients diagnosed with hypercapnic type 2 respiratory failure between May 2022 and May 2023 were included. Patients were categorized based on the presence of AF. Demographic, laboratory, and echocardiographic findings, comorbidities, and outcomes were compared. Kaplan–Meier survival analysis and Cox regression were used to identify mortality predictors. Results: AF was present in 50.5% of patients. Those with AF were older, had higher Charlson Comorbidity Index scores, and a greater prevalence of heart failure (p<0.001). No significant differences were found in arterial blood gas values. AF patients had higher urea, creatinine, and BNP levels, and lower hemoglobin, lymphocyte, eosinophil, and monocyte counts (p<0.05). Echocardiography showed more severe tricuspid and mitral regurgitation, lower ejection fractions, and higher systolic pulmonary pressures in the AF group. About 20% of AF patients were not receiving anticoagulants at ICU admission. AF was associated with shorter survival (49.6±4.07 vs. 61.4±3.8 days, p = 0.031) and 1.6-fold higher mortality risk (HR: 1.60, 95% CI: 1.04–2.47). Advanced age and low hemoglobin were independent predictors of mortality. Conclusion: AF is frequent among patients with type 2 respiratory failure and is linked to increased mortality. Despite known complications, treatment remains underutilized. AF should be actively screened during ICU admissions for respiratory failure.