Predictors and Prognosis in Perioperative Complications and Survival among Elderly Hip Fracture Patients with Paroxysmal or Permanent Atrial Fibrillation: a nested case–control study

Predictors and Prognosis in Perioperative Complications and Survival among Elderly Hip Fracture Patients with Paroxysmal or Permanent Atrial Fibrillation: a nested case–control study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Predictors and Prognosis in Perioperative Complications and Survival among Elderly Hip Fracture Patients with Paroxysmal or Permanent Atrial Fibrillation: a nested case–control study Wei Li, Ao ying Min, Wei Zhao, Weining Li, Shuhan Li, Saidi Ran, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4177324/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 03 Jan, 2025 Read the published version in BMC Geriatrics → Version 1 posted 8 You are reading this latest preprint version Abstract Background A dearth of data exists concerning atrial fibrillation (AF) during the perioperative stage of non-cardiothoracic surgery, particularly orthopaedic surgery. Therefore, given the frequency and significant impact of AF in the perioperative period. We need to make sure the prognosis of paroxysmal and permanent AF and the predictors of perioperative paroxysmal AF. Methods An examination of hip fracture patients at the Third Hospital of Hebei Medical University, who had been hospitalized from January 2018 to October 2020 in succession, was conducted retrospectively. To determine independent risk factors for paroxysmal AF in elderly hip fracture patients, univariate and multivariate logistic regression analysis were employed. The Kaplan-Meier survival curve demonstrated the correlation between all-cause mortality in the non-AF, paroxysmal AF, and permanent AF groups. An assessment of the correlation between baseline factors, complications, and all-cause mortality was conducted through univariable and multivariable Cox proportional hazards analysis. Results Enrolling 1,376 elderly patients with hip fractures, we found 1,189 in the non-AF group, 103 in the paroxysmal AF group, and 84 in the permanent AF group. Of the 1376 patients, the majority were female (70.3%) with an average age of 79.51 years, and the majority of them were over 75 years of age (72.5%) - the majority. Kaplan-Meier plots revealed a significantly lower overall survival rate in elderly individuals suffering from hip fracture, as well as especially permanent AF. Based on our COX regression analysis, we found that the main risk factors for all-cause death in elderly patients with hip fracture combined with AF patients were concomitant pulmonary infection, hyponatremia, permanent AF and age. Elderly patients with hip fracture combined with paroxysmal AF group showed a higher incidence of perioperative complications, such as hypertension, COPD and ACCI were independent risk factors for paroxysmal AF in elderly patients with hip fracture. Conclusions The prevention of paroxysmal AF in elderly patients with hip fractures is of paramount importance. And avert complications and potential mortality also significant, elderly patients with hip fracture, particularly those with permanent AF, must be given suitable perioperative care to avert the risks of pulmonary infection and hyponatremia. Non- atrial fibrillation Paroxysmal atrial fibrillation Permanent atrial fibrillation Hip fracture Risk factors Prognosis Elderly Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Introduction The prevalence of AF (atrial fibrillation) is not only widespread, but also a major complication following surgery for numerous patients [ 1 , 2 ], and is associated with poor outcomes, with incidence rates ranging from 2–60%[ 3 ]. and its outcomes are often unsatisfactory. The health and economic burden of AF has now reached an epidemic level [ 4 ]. As the population continues to age, the number of people aged 60 and over will reach 2 billion by 2050[ 5 ], Research has demonstrated a steady rise in AF prevalence and mortality[ 6 ]. and a correlation between AF and the risk of fractures [ 7 ]. The number of hip fractures is increasing as the world's population ages, Mortality and dysfunction associated with hip fracture in elderly adults represent a significant burden to society[ 8 ]. Surgery has now become the preferred way to treat hip fractures[ 9 ]. Among patients who underwent hip fracture surgery, 1-year mortality and 1-year readmission rates are reported to be higher in those with perioperative AF[ 3 ]. According to one report, 80% would rather die than be hospitalized after breaking the hip, therefore, the most important task for older people is the prevention of hip fractures[ 10 ]. The occurrence of AF is very bad for patients because atrial fibrillation can be the cause of heart failure and blood circulation problems, which can increase the risk of ischemia, thrombosis, stroke and other serious consequences[ 11 ]. AF is associated with an increased risk of heart failure, heart attack and stroke, thromboembolism, stroke, dementia, and overall mortality[ 12 ]. Additionally, hypertension and chronic obstructive pulmonary disease have been identified as other risk factors associated with perioperative AF[ 13 ]. It has been shown that all-cause mortality at 10 years is 30.3% after a first electrocardiographic diagnosis of paroxysmal AF[ 14 ]. Palpitations and chest pain are more common in patients with paroxysmal AF[ 15 ], and are much more likely to be suitable for a rhythm control strategy, a much more complicated undertaking[ 16 ]. In patients with permanent AF, the predominant symptom is dyspnoea[ 15 ], and there is an increased likelihood that they will die[ 17 ]. The prognosis for complications and long-term mortality in hip surgery patients with paroxysmal and permanent AF is currently uncertain, and the risk factors for paroxysmal AF in perioperative hip fracture remain largely unknown. This article seeks to identify the predictors and prognosis of elderly hip fractures related to perioperative AF (both paroxysmal AF and permanent AF). However, investigating the predictors of permanent AF poses a challenge. Our ultimate objective is to investigate the prognosis of both paroxysmal and permanent AF, as well as the factors that predict perioperative paroxysmal AF. Methods Patients and groups A retrospective study of hip fracture patients aged 65 or above, who were admitted to Hebei Medical University's Third Hospital from January 2018 to October 2020, was sanctioned by the Institutional Review Board. Furthermore, the Third Hospital granted a waiver for informed consent. People aged 65 and over who had a hip fracture, were willing to participate voluntarily, and had normal communication and comprehension skills were included in this study. Conversely, those with a pathological fracture, multiple fractures or old fractures, incomplete clinical data and those without surgery were excluded. In compliance with European Society of Cardiology (ESC) guidelines[ 18 ], three groups were identified for the study: (1) those without AF, (2) those with paroxysmal AF, and (3) those with permanent AF. Those with pathological fractures, multiple fractures, or old fractures, incomplete clinical data, and those without surgery were excluded. All AF patients were diagnosed accordingly. Data collection Demographics, including age, gender, comorbidities (hypertension, coronary heart disease, diabetes, COPD, cancer, stroke), prognostic indicators (pulmonary infection, heart failure, stress ulcer, urinary tract infection, stress hyperglycemia, anemia, acute atrial fibrillation, acute cerebrovascular disease, hyponatremia, hypokalemia, hypoproteinemia), length of stay, and all-cause mortality, were all collected. Signs like hip fracture, anesthesia, and surgery type were also noted. Patients were followed from discharge until 1 October 2022, during which time their relatives were notified of their death by telephone. Definition Classifying AF types into paroxysmal and permanent, we followed the European Society of Cardiology's guidelines. Paroxysmal AF was determined to be a self-terminating condition that lasted no longer than 7 days, and our diagnosis of it was mainly based on ECG monitoring and electrocardiogram. Permanent AF, on the other hand, was defined as AF in which cardioversion therapy either failed or was not attempted. We diagnose permanent atrial fibrillation by asking medical history[ 18 ]. Statistical analysis The Shapiro-Wilk test was employed to assess the regularity of the continuous variables. Generally distributed variables were represented as the mean and standard deviation (SD); if not, they were shown as the median and interquartile range. Categorical variables were depicted as figures and percentages. A Mann-Whitney U test or Student's t-test was employed to contrast the differences between groups for continuous variables as suitable, while the Chi-square or Fisher exact test was utilized for categorical variables. To ascertain independent risk factors for paroxysmal AF in elderly patients with hip fractures, univariate and multivariate Logistic regression analysis was conducted. The Kaplan-Meier method was used to estimate the survival. Using SPSS statistical software (version 25.0) and GraphPad Prism software (version 9.0), Cox proportional hazards regression model was utilized to conduct both univariate and multivariate analyses of survival outcomes, with the level of significance set at P < 0.05, in order to identify independent prognostic factors. Results Demographic characteristics Between January 2018 and October 2020, a total of 1873 patients over the age of 65 years were admitted to our department for a hip fracture. Specifically, among them, 497 patients were excluded and 1376 cases remained in the final analysis. 148 patients had old fractures or pathological fractures; 76 patients had multiple fractures; and 95 patients had incomplete data; 178 patients received non-surgical treatment. Among them, 1189 patients had non-AF patients, 103 patients were paroxysmal AF and 84 patients had permanent AF. (Fig. 1 ). Patient characteristics at baseline The characteristics of the three groups of patients, including age, gender, fracture type, complications, surgery type, and anesthesia, were outlined in Table 1 in terms of basic characteristics. The characteristics of the 1376 patients were presented. Of the patients, 70.3% were female, and the average age was 79.51 years. People aged over 75 (72.5%) made up the largest proportion of these participants. Table 1 Baseline characteristics of geriatric patients with hip fracture Total (n = 1376) NAF (n = 1189) AF Par AF (n = 103) (n = 187) Per AF (n = 84) Age, mean ± SD (years) 79.51 ± 7.346 79.29 ± 7.419 82.17 ± 6.790 79.44 ± 6.335 Age group, n (%) < 75 years ≥ 75 years ACCI(IQR) 379(27.5%) 997(72.5%) 5(4–5) 344(28.9%) 845(71.1%) 5(4–5) 17(16.5%) 86(83.5%) 6(4–6) 18(21.4%) 66(78.6%) 5(4–6) Gender, n (%) Male Female 408(29.7%) 968(70.3%) 348(29.3%) 841(70.7%) 36(35.0%) 67(65.0%) 24(28.6%) 60(71.4%) Fracture types, n (%) Femoral neck fractures Intertrochanteric fractures Comorbidities, n (%) Hypertension Stroke Coronary heart disease Diabetes COPD Cancer Surgical type, n (%) Replacement Fixation Anesthesia type, n (%) General Lumbar 648(47.1%) 728(52.9%) 664(48.3%) 540(39.2%) 368(26.7%) 300(21.8%) 47(3.4%) 62(4.5%) 586(42.6%) 790(57.4%) 792(57.6%) 584(42.4%) 556(46.8%) 633(53.2%) 538(45.2%) 446(37.5%) 294(24.7%) 254(21.4%) 28(2.4%) 53(4.5%) 503(42.3%) 686(57.7%) 686(57.7%) 503(42.3%) 58(56.3%) 45(43.7%) 69(67.0%) 49(47.6%) 47(45.6%) 18(17.5%) 15(14.6%) 5(4.9%) 52(50.5%) 51(49.5%) 57(55.3%) 46(44.7%) 34(40.5%) 50(59.5%) 57(67.9%) 45(53.6%) 27(32.1%) 28(33.3%) 10(11.9%) 4(4.8%) 31(36.9%) 53(63.1%) 49(58.3%) 35(41.7%) Values are presented as mean ± standard deviation, median (interquartile range), or number (percentage) as appropriate SD Standard deviation, AF Atrial fibrillation, NAF Non atrial fibrillation, Par AF Paroxysmal atrial fibrillation, Per AF Permanent atrial fibrillation, COPD Chronic obstructive pulmonary disease, ACCI Age-Adjusted Charlson Comorbidity Index Comparison of the outcomes of patients with NAF and AF in elderly patients with hip fracture Table 2 described the outcomes for the three groups, including complications, length of stay and overall mortality. Table 3 showed the impact of perioperative complications, length of stay and all-cause mortality in elderly patients with a hip fracture. The incidence of pulmonary infection, heart failure, stress ulcer, urinary tract infection, acute cerebrovascular disease, hypokalemia, length of stay, and all-cause mortality was higher in those without AF, which was statistically significant (P < 0.05). However, there was no significant difference in the anemia, stress hyperglycemia, hypoproteinemia and hypokalemia between the two groups. We also found that anemia and hypoproteinemia were the most common complications in both groups. At the end of the research, the permanent AF cohort had 38 fatalities (20.3%) as demonstrated by the Kaplan-Meier survival curve (Fig. 2 ), which was greater (log rank p < 0.001) than the non-AF group (8.7%) and the paroxysmal AF group (13.5%). Furthermore, fatalities (29.8%) in the permanent AF cohort were higher than those in the paroxysmal AF group and the non-AF group, as demonstrated by the Kaplan-Meier survival curve (Fig. 3 ) (Log Rank p < 0.001). And the Kaplan-Meier survival curve (Fig. 4 ) showed that perioperative mortality from hyponatremia was higher in elderly patients with hip fracture and atrial fibrillation (29.8%) than in the non hyponatremia group (Log Rank p = 0.01).In addition, the Kaplan-Meier survival curve (Fig. 5 ) showed that perioperative mortality from pulmonary infection was higher in elderly patients with hip fracture and atrial fibrillation (29.8%) than in the non pulmonary infection group (Log Rank p = 0.005). Table 2 Comparison of the outcomes of patients with non- atrial fibrillation paroxysmal atrial fibrillation and permanent atrial fibrillation in elderly patients with hip fracture Total (n = 1376) NAF (n = 1189) AF Par AF (n = 103) (n = 187) Per AF (n = 84) Pulmonary infection 204(14.8%) 162(13.6%) 21(20.4%) 21(25.0%) Heart failure 421(30.6%) 329(27.7%) 44(42.7%) 48(57.1%) Stress ulcer 25(1.8%) 9(0.8%) 7(6.8%) 9(10.7%) Urinary tract infection 49(3.6%) 33(2.8%) 8(7.8%) 8(9.5%) Anemia 648(47.1%) 553(46.5%) 51(49.5%) 44(52.4%) Stress hyperglycemia 52(3.8%) 45(3.8%) 3(2.9%) 4(4.8%) Acute cerebrovascular disease Hyponatremia Hypokalemia Hypoalbuminemia Hospital stay (IQR), days All-cause mortality 51(3.7%) 421(30.6%) 325(23.6%) 700(50.9%) 12(10,16) 141(10.3%) 16(1.3%) 359(30.2%) 261(22.0%) 606(51.0%) 12(10,16) 103(8.7%) 17(16.5%) 38(36.9%) 45(43.7%) 55(53.4%) 13(10,17) 13(13.5%) 18(21.4%) 24(28.6%) 19(22.6%) 39(46.4%) 13(11,17) 25(29.8%) Values are presented as mean ± standard deviation, median (interquartile range), or number (percentage) as appropriate AF Atrial fibrillation, NAF Non atrial fibrillation, Par AF Paroxysmal atrial fibrillation, Per AF Permanent atrial fibrillation Table 3 Comparison of the outcome of patients with non- atrial fibrillation and atrial fibrillation in old patients with hip fracture Total (n = 1376) NAF (n = 1189) AF (n = 187) P值 Pulmonary infection 204(14.8%) 162(13.6%) 42(22.5%) 0.002 Heart failure 421(30.6%) 329(27.7%) 92(49.2%) <0.001 Stress ulcer 25(1.8%) 9(0.8%) 16(8.6%) <0.001 Urinary tract infection 49(3.6%) 33(2.8%) 16(8.6%) <0.001 Anemia 648(47.1%) 553(46.5%) 95(50.8%) 0.274 Stress hyperglycemia 52(3.8%) 45(3.8%) 7(3.7%) 0.978 Acute cerebrovascular disease Hyponatremia Hypokalemia Hypoalbuminemia Hospital stay (IQR), days All-cause mortality 51(3.7%) 421(30.6%) 325(23.6%) 700(50.9%) 12(10,16) 141(10.2%) 16(1.3%) 359(30.2%) 261(22.0%) 606(51.0%) 12(10,16) 103(8.7%) 35(18.7%) 62(33.2%) 64(34.2%) 94(50.3%) 13(10,17) 38(20.3%) <0.001 0.414 <0.001 0.859 0.010 <0.001 Values are presented as mean ± standard deviation, median (interquartile range), or number (percentage) as appropriate AF Atrial fibrillation, NAF Non atrial fibrillation, Par AF Paroxysmal atrial fibrillation, Per AF Permanent atrial fibrillation Clinical variables predicting all-cause mortality in patients with AF Table 4 described the relationship between all-cause mortality and relevant clinical variables in elderly AF patients with hip fracture. Univariate COX analysis showed that age over 75 years, permanent AF, pulmonary infection, stress ulcer, heart failure, and hyponatremia were also associated with all-cause mortality (p <0.05). The multivariate COX proportional risk model incorporated the factors chosen from the univariate COX regression analysis. Because stress ulcers were rare and accidental, so they were not introduced. Independent risk factors for all-cause mortality in patients identified by multivariate COX proportional risk model, which included age over 75 (HR 2.990,95%CI 0.909–9.836, P = 0.071), permanent AF (HR 2.806, 95%CI 1.036–4.198, P = 0.039), pulmonary infection (HR 2.006,95%CI 1.019–3.949, P = 0.044), hyponatremia (HR 2.417,95%CI 1.177–4.961, P = 0.016). A forest plot was employed to illustrate the risk factors that foretold all-cause mortality in AHF patients, as depicted in Fig. 6 Table 4 Cox proportional risk regression model for overall survival in patients with atrial fibrillation Varibles Univariate HR (95% CI) P value Multivariate HR (95% CI) P value Age ≥ 75 Gender 3.180(0.997–10.348) 1.615(0.764–3.414) 0.055 0.210 2.990(0.909–9.836) 0.071 Fracture types Permanent AF 1.801(0.921–3.522) 2.140(1.093–4.193) 0.085 0.027 2.806(1.036–4.198) 0.039 Pulmonary infection 2.495(1.287–4.835) 0.007 2.006(1.019–3.949) 0.044 Heart failure 2.033(1.051–3.934) 0.035 0.999(0.467–2.139) 0.998 Stress ulcer 3.238(1.421–7.380) 0.005 2.646(1.091–6.416) 0.031 Urinary tract infection 0.292(0.040–2.130) 0.225 Anemia 1.433(0.752–2.730) 0.274 Stress hyperglycemia 1.980(0.472–8.311) 0.351 Acute cerebrovascular disease Surgical type Anesthesia type Hyponatremia Hypokalemia Hypoalbuminemia Hospital stay (IQR), days 0.891(0.372–2.133) 1.685(0.850–3.341) 0.567(0.289–1.111) 2.275(1.199–4.317) 1.483(0.772–2.848) 1.473(0.773–2.807) 0.987(0.929–1.049) 0.796 0.135 0.098 0.012 0.236 0.239 0.675 2.417(1.177–4.961) 0.016 Hypokalemia = potassium level < 3.5 mmol/L. Hyponatremia = sodium level<135 mmol/L, Hypoalbuminemia = albumin level<35g/L Abbreviations: HR Hazard ratio, CI Confidence interval Non AF and paroxysmal AF Patient characteristics at baseline Table 5 summarized the characteristics of the hip fracture patients with NAF and paroxysmal AF. Most patients were women (70.3%), and the top four comorbidities were hypertension (47.0%), stroke (38.3%), coronary heart disease (26.4%), and COPD (3.3%). No distinctions between genders were observed between the groups, yet age was distinct; paroxysmal AF patients were older than NAF patients (82.17 ± 6.790 years for paroxysmal AF, 79.29 ± 7.419 years for NAF, p < 0.001). The burden of chronic diseases, as assessed by the age-adjusted Charlson Comorbidity Index (ACCI), was higher in patients with paroxysmal AF than in those with NAF (5(4–5) versus 6(4–6), p < 0.001). Statistically, a significant distinction was observed between those with a history of hypertension, stroke, COPD, and coronary heart disease (p < 0.05). Despite the fact that those with paroxysmal atrial fibrillation appeared to have a greater prevalence of diabetes and cancer, no noteworthy disparity was discovered. Additionally, age ≥ 75 was found to be significantly higher among patients with paroxysmal AF. Table 5 Baseline characteristics of geriatric hip fracture patients with non-atrial fibrillation and paroxysmal atrial fibrillation Total (n = 1292) NAF (n = 1189) Par AF (n = 103) F/t/z P值 Age, mean ± SD (years) 79.51 ± 7.409 79.29 ± 7.419 82.17 ± 6.790 3.804 <0.001 Age group, n (%) < 75 years ≥ 75 years 361(27.9%) 931(72.1%) 344(28.9%) 845(71.1%) 17(16.5%) 86(83.5%) 7.270 0.007 Gender, n (%) Male Female ACCI Fracture types, n (%) 384(29.7%) 908(70.3%) 5(4–5) 348(29.3%) 841(70.7%) 5(4–5) 36(35.0%) 67(65.0%) 6(4–6) 1.466 7.259 0.226 <0.001 Femoral neck fractures Intertrochanteric fractures Comorbidities, n (%) Hypertension Stroke Coronary heart disease Diabetes COPD Cancer Surgical type, n (%) Replacement Fixation Anesthesia type, n (%) General Lumbar 614(47.5%) 678(52.5%) 607(47.0%) 495(38.3%) 341(26.4%) 272(21.1%) 43(3.3%) 58(4.5%) 555(43.0%) 737(57.0%) 743(57.5%) 549(42.5%) 556(46.8%) 633(53.2%) 538(45.2%) 446(37.5%) 294(24.7%) 254(21.4%) 28(2.4%) 53(4.5%) 503(42.3%) 686(57.7%) 686(57.7%) 503(42.3%) 58(56.3%) 45(43.7%) 69(67.0%) 49(47.6%) 47(45.6%) 18(17.5%) 15(14.6%) 5(4.9%) 52(50.5%) 51(49.5%) 57(55.3%) 46(44.7%) 3.466 17.989 4.061 21.322 0.862 43.909 0.035 2.589 0.215 0.063 <0.001 0.044 <0.001 0.353 <0.001 0.852 0.108 0.643 Values are presented as mean ± standard deviation, median (interquartile range), or number (percentage) as appropriate SD Standard deviation, AF Atrial fibrillation, NAF Non atrial fibrillation, Par AF Paroxysmal atrial fibrillation, Per AF Permanent atrial fibrillation, COPD Chronic obstructive pulmonary disease, ACCI Age-Adjusted Charlson Comorbidity Index Clinical variables predicting the appearance of paroxysmal AF Univariate logistic analysis (p < 0.05) revealed a correlation between age, ACCI, combined hypertension, stroke, coronary heart disease, and COPD and paroxysmal AF in elderly patients with hip fracture. Table 6 further demonstrated this association. To further investigate this, a multivariate logistic proportional hazards model was then implemented. Elderly patients with hip fracture who have combined hypertension (OR 2.248, 95% CI 1.415–3.571, P = 0.001), COPD (OR 4.694, 95% CI 2.207–9.980,P<0.001), ACCI(OR 1.436, 95%CI 1.072–1.924, P = 0.015)were at an increased risk for perioperative . Table 6 Univariate and multivariate Logistic regression analysis for factors associated with perioperative Paroxysmal AF in old patients with hip fracture Varibles Univariate OR (95% CI) P value Multivariate OR (95% CI) P value Age Gender 1.056(1.026–1.086) 0.770(0.504–1.177) <0.001 0.227 1.031(0.992–1.071) 0.125 Fracture types 0.681(0.454–1.022) 0.064 ACCI 1.800(1.522–2.128) <0.001 1.436(1.072–1.924) 0.015 Hypertension 2.456(1.603–3.761) <0.001 2.248(1.415–3.571) 0.001 Stroke 1.512(1.009–2.264) 0.045 0.844(0.494–1.442) 0.535 Coronary heart disease 2.555(1.696–3.848) <0.001 1.305(0.761–2.236) 0.333 Diabetes COPD Cancer Surgical type Anesthesia type 0.780(0.460–1.321) 7.068(3.640-13.723) 1.094(0.427–2.799) 0.719(0.481–1.076) 1.101(0.734–1.650) 0.354 <0.001 0.852 0.109 0.643 4.694(2.207–9.980) <0.001 N 1292 (cases: 103, controls: 1189) Abbreviations: OR Odds ratio, CI Confidence interval COPD Chronic obstructive pulmonary disease, ACCI Age-Adjusted Charlson Comorbidity Index Discussion Clinical outcomes Our ultimate goal was to investigate the prognosis of elderly hip fracture patients with both paroxysmal and permanent AF, as well as the prognosticators of elderly hip fracture patients with perioperative paroxysmal AF, with a prevalence of 7.5% in our group. Permanent AF had significantly more heart failure, all-cause mortality, and hypokalemia and hyponatremia complications than paroxysmal AF. In our cohort, elderly hip fracture patients with permanent atrial fibrillation had generally poorer outcomes than those with paroxysmal AF. Moreover, permanent AF was identified as a separate risk factor for all-cause mortality post-surgery, in addition to other baseline conditions and multiple comorbidities. Age, pulmonary infection, and hyponatremia were also independent risk factors for death in these patients. The incidence of hip fracture in elderly patients with paroxysmal AF was linked to ACCI, hypertension, and COPD. Comparison with other studies AF, even in those without other TCVRFs (standard cerebrocardiovascular risk factors), is an independent hazard for stroke and all-cause cardiovascular mortality [ 4 ]. AF and heart failure are two conditions that are often associated with each other, as AF facilitates HF to occur and vice-versa[ 19 ]. The cause of AF and heart failure may be a 25% decrease in cardiac ejection fraction, which in turn leads to a decrease in cardiac coronary perfusion. This, in turn, causes a decrease in coronary perfusion, and a decrease in the blood supply to the atria, thus resulting in an atrial heart rhythm disorder[ 20 – 22 ]. Patients with atrial fibrillation demonstrate a significantly greater incidence of stress ulcer than those without. It is thought to occur with an incidence of 0.2–2% in the post-operative period, according to several reviews, although this is lower than many of the post-operative complications[ 23 ]. Our research reveals that those with atrial fibrillation have a significantly higher prevalence of hypokalemia than those without. In elderly adults with AF, this rate is 30.98% of the total. Hypokalemia has a strong association with death from cardiovascular causes[ 24 ]. The incidence of acute cerebrovascular disease in patients with AF is significantly greater than in those without AF, and ischemic stroke or transient ischemic attack (TIA) is the first manifestation of AF in 2 to 5% of them, with a fivefold increased risk of stroke.[ 25 ]. We find that in patients with AF, permanent AF is an independent indicator of mortality. The prevailing view is that permanent and persistent AF patterns are associated with poorer survival[ 26 , 27 ]. Amalia Baroutid's study revealed that, at a median follow-up of 31 months (interquartile range 10 to 52 months), 37.3% of patients perished. In comparison to those with paroxysmal AF, permanent AF patients had a higher mortality rate (adjusted hazard ratio (aHR),1.37; 95% confidence interval [CI],1.08–1.74, P ¼).009), but similar rates of CV mortality or hospitalization (aHR, 1.09; 95%CI, 0.91–1.31, P ¼ .35)[ 28 – 30 ]. This result is in line with our findings. Pulmonary infection is an independent indicator of AF mortality in those with hip fracture and AF. Pneumonia is a common complication of hip fracture and can increase mortality by up to four times[ 31 ]. Patients with pneumonia may cough, produce sputum, have difficulty breathing or have fever[ 32 ]. Though progress has been made in the production of antibiotics, mortality from pneumonia persists, particularly as the amount of high-risk patients has risen [ 33 ]. A serum sodium concentration of less than 135 mEq/L is what defines hyponatremia, an electrolyte abnormality that is often seen in heart failure patients and has been linked to adverse results. Its prevalence ranges from 13.8–33.7%. Hyponatremia is an independent predictive risk factor for death in hip fracture patients with comorbid AF, as confirmed by the study of Aydın Akyüz et al[ 34 – 36 ]. Charlson et al. created the Charlson Comorbidity Index, a tool for assessing the mortality risk due to comorbidities[ 37 ]. However, there is no research on the correlation between ACCI (age-adjusted Charlson Comorbidity Index) and perioperative AF in hip fracture patients. In our study, ACCI is identified as a significant predictor of perioperative AF in geriatric hip fracture patients. Hypertension and COPD have been identified as risk factors for perioperative AF associated with surgery [ 13 ]. The results of Monika Gawałko et al are consistent with ours. Hypertension is prevalent in > 70% of patients with AF. Patients suffering from hypertension have a significantly greater chance of AF, potentially up to 73% higher in risk. Current guidelines recommend that systematic AF screening may be warranted in all patients aged ≥ 65 years with at least one cardiovascular disease, including hypertension.[ 38 ] Both AF and COPD are significant global contributors to health-care burden, and they frequently coexist due to their shared pathophysiology. A study utilizing the Spanish National Hospital Discharge Database discovered that COPD is a common comorbidity in patients hospitalized for AF[ 39 ]. In the Atherosclerosis Risk in Community (ARIC) cohort study [ 40 ], COPD and reduced lung function have been independently linked to the emergence of AF, despite the presence of risk factors for cardiovascular disease (e.g. smoking) in many COPD patients that may be confounding factors.[ 40 ]. The co-existence of COPD and AF is a well established fact: Sidney et al. A cohort study of 45,966 patients was conducted retrospectively, with a case-control approach. They found a 4.41-fold increased risk of AF in COPD, something that was reproduced[ 41 ]. COPD triggers pathological processes including hypoxia, electrolyte imbalances and altered pulmonary hemodynamics. Oxidative stress and chronic systemic inflammation, resulting in hypoxia, increased expression of matrix metalloproteinases (MMPs) and atrial remodelling, can be the catalysts for the emergence of arrhythmia. In particular, COPD-induced atrial myocyte dysfunction and fibrosis are the cause of this (2010)[ 42 ]. Pulmonary hypertension and elevated pCO2 levels also result from hypoxia, are risk factors for AF, as is elevated systolic blood pressure[ 43 ]. Finally, COPD patients may have low serum potassium levels due to electrolyte disturbances caused by overuse of corticosteroids or beta-blockers. The p-wave's length is augmented, a hazard factor for AF, as a result of this.[ 44 ]. Limitations This study is limited and needs to be interpreted. First of all, the study is a retrospective study and a single-center study. Secondly, because there are fewer patients with AF, there are differences in some outcomes. Conclusions Our study shows that older hip fracture patients with AF have more complications and mortality than those without. Independent risk factors for death from AF include age, pneumonia and hyponatremia. Patients diagnosed with AF, particularly those with permanent AF, should prioritize the prevention and management of pulmonary infections and hyponatremia. Patients with hip fracture aged 75 and over are particularly prone to paroxysmal AF, with ACCI, hypertension, and COPD being identified as independent risk factors. Consequently, patients with this condition should focus on preventing paroxysmal AF. Abbreviations AF Atrial fibrillation NAF Non atrial fibrillation Par AF Paroxysmal atrial fibrillation Per AF Permanent atrial fibrillation COPD Chronic obstructive pulmonary disease ACCI Age-adjusted Charlson Comorbidity Index Declarations Acknowledgments None Authors’ contributions ZQ. W and ZY. H conceived the study. W. L, AY.M and W. Z supported study preparation and data collection. WN. L, SH.L, SD.R, QI.Y, MM,F and JK.K collected the data and drafted the manuscript. ZQ. W and ZY. H critically reviewed the manuscript for important intellectual content. All authors approved the final version of the manuscript. Availability of data and materials The data supporting the findings of this study are available upon request from Zhi qian Wang. Ethics approval and consent to participate The ethics committee of the Third Hospital of Hebei Medical University gave their approval to this study protocol, in accordance with the Helsinki Declaration (approval number 2021-087-1) and an exemption from obtaining informed consent was granted due to the retrospective nature of the data collection. To ensure patient privacy, all data was anonymized before analysis. Consent for publication Not applicable. Competing interests The authors declare no competing interests. Author details 1 At the Third Hospital of Hebei Medical University, located in Shijiazhuang, Hebei, People's Republic of China, lies the Department of Geriatric Orthopedics. The Third Hospital of Hebei Medical University also houses the Department of Ortho-paedic Surgery. Additionally, the NHC Key Laboratory of Intelligent Ortho-peadic Equipment is situated in the same hospital. Lastly, the Chinese Academy of Engineering is located in Beijing, People's Republic of China. Publisher’s Note Springer Nature remains neutral with regard to jurisdictional claims in pub- lished maps and institutional affiliations. References Bhave, P.D., et al., Incidence, predictors, and outcomes associated with postoperative atrial fibrillation after major noncardiac surgery. American Heart Journal, 2012. 164 (6): p. 918-924. Alonso-Coello, P., et al., Predictors, Prognosis, and Management of New Clinically Important Atrial Fibrillation After Noncardiac Surgery: A Prospective Cohort Study. Anesth Analg, 2017. 125 (1): p. 162-169. Leibowitz, D., et al., Perioperative atrial fibrillation is associated with increased one-year mortality in elderly patients after repair of hip fracture. Int J Cardiol, 2017. 227 : p. 58-60. Sairenchi, T., et al., Atrial Fibrillation With and Without Cardiovascular Risk Factors and Stroke Mortality. Journal of Atherosclerosis and Thrombosis, 2021. 28 (3): p. 241-248. Boe, D.M., L.A. Boule, and E.J. Kovacs, Innate immune responses in the ageing lung. Clin Exp Immunol, 2017. 187 (1): p. 16-25. Go, A.S., et al., Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. Jama, 2001. 285 (18): p. 2370-5. Sennerby, U., et al., Cardiovascular diseases and risk of hip fracture. Jama, 2009. 302 (15): p. 1666-73. Johnell, O. and J.A. Kanis, An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int, 2006. 17 (12): p. 1726-33. Prince, M.J., et al., The burden of disease in older people and implications for health policy and practice. Lancet, 2015. 385 (9967): p. 549-62. Berry, S.D., D.P. Kiel, and C. Colón-Emeric, Hip Fractures in Older Adults in 2019. Jama, 2019. 321 (22). Prince-Wright, L.H., et al., Postoperative atrial fibrillation following non-cardiac surgery: Predictors and risk of mortality. 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Steinberg, B.A., et al., Rate versus rhythm control for management of atrial fibrillation in clinical practice: results from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF) registry. Am Heart J, 2013. 165 (4): p. 622-9. Steinberg, B.A., et al., Higher risk of death and stroke in patients with persistent vs. paroxysmal atrial fibrillation: results from the ROCKET-AF Trial. Eur Heart J, 2015. 36 (5): p. 288-96. Camm, A.J., et al., Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur Heart J, 2010. 31 (19): p. 2369-429. Bergau, L., et al., Atrial Fibrillation and Heart Failure. Journal of Clinical Medicine, 2022. 11 (9). Jalife, J. and K. Kaur, Atrial remodeling, fibrosis, and atrial fibrillation. Trends Cardiovasc Med, 2015. 25 (6): p. 475-84. Sohns, C. and N.F. Marrouche, Atrial fibrillation and cardiac fibrosis. 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Am J Cardiol, 2005. 96 (10): p. 1420-4. Baroutidou, A., et al., Associations of Atrial Fibrillation Patterns With Mortality and Cardiovascular Events: Implications of the MISOAC-AF Trial. Journal of Cardiovascular Pharmacology and Therapeutics, 2022. 27 . Tzikas, A., et al., Motivational Interviewing to Support Oral AntiCoagulation adherence in patients with non-valvular Atrial Fibrillation (MISOAC-AF): a randomized clinical trial. Eur Heart J Cardiovasc Pharmacother, 2021. 7 (Fi1): p. f63-f71. Samaras, A., et al., Rationale and design of a randomized study comparing Motivational Interviewing to Support Oral Anticoagulation adherence versus usual care in patients with nonvalvular atrial fibrillation: The MISOAC-AF trial. Hellenic J Cardiol, 2020. 61 (6): p. 453-454. Kjørholt, K.E., et al., Increased risk of mortality after postoperative infection in hip fracture patients. Bone, 2019. 127 : p. 563-570. Marrie, T.J., Community-acquired pneumonia. Clin Infect Dis, 1994. 18 (4): p. 501-13; quiz 514-5. File, T.M., Community-acquired pneumonia. Lancet, 2003. 362 (9400): p. 1991-2001. Farmakis, D., et al., Hyponatremia in heart failure. Heart Fail Rev, 2009. 14 (2): p. 59-63. Sica, D.A., Hyponatremia and heart failure--pathophysiology and implications. Congest Heart Fail, 2005. 11 (5): p. 274-7. Bavishi, C., et al., Prognostic significance of hyponatremia among ambulatory patients with heart failure and preserved and reduced ejection fractions. Am J Cardiol, 2014. 113 (11): p. 1834-8. Charlson, M.E., et al., A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis, 1987. 40 (5): p. 373-83. Gawałko, M. and D. Linz, Atrial Fibrillation Detection and Management in Hypertension. Hypertension, 2023. 80 (3): p. 523-533. Méndez-Bailón, M., et al., Chronic obstructive pulmonary disease predicts higher incidence and in hospital mortality for atrial fibrillation. An observational study using hospital discharge data in Spain (2004-2013). Int J Cardiol, 2017. 236 : p. 209-215. Li, J., et al., Airflow obstruction, lung function, and incidence of atrial fibrillation: the Atherosclerosis Risk in Communities (ARIC) study. Circulation, 2014. 129 (9): p. 971-80. Sidney, S., et al., COPD and incident cardiovascular disease hospitalizations and mortality: Kaiser Permanente Medical Care Program. Chest, 2005. 128 (4): p. 2068-75. Zhang, L., et al., Structural changes in the progression of atrial fibrillation: potential role of glycogen and fibrosis as perpetuating factors. Int J Clin Exp Pathol, 2015. 8 (2): p. 1712-8. Terzano, C., et al., Atrial fibrillation in the acute, hypercapnic exacerbations of COPD. Eur Rev Med Pharmacol Sci, 2014. 18 (19): p. 2908-17. Krijthe, B.P., et al., Serum potassium levels and the risk of atrial fibrillation: the Rotterdam Study. Int J Cardiol, 2013. 168 (6): p. 5411-5. Additional Declarations No competing interests reported. Supplementary Files Supplementarymaterial.pdf Cite Share Download PDF Status: Published Journal Publication published 03 Jan, 2025 Read the published version in BMC Geriatrics → Version 1 posted Editorial decision: Revision requested 23 Jun, 2024 Reviews received at journal 12 Jun, 2024 Reviewers agreed at journal 12 Jun, 2024 Reviewers invited by journal 10 May, 2024 Editor assigned by journal 10 May, 2024 Editor invited by journal 29 Mar, 2024 Submission checks completed at journal 29 Mar, 2024 First submitted to journal 27 Mar, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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16:00:47","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4177324/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4177324/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12877-024-05647-1","type":"published","date":"2025-01-03T15:57:14+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":54035734,"identity":"3cb50b4e-9f2a-48b1-b05c-d69368501aaf","added_by":"auto","created_at":"2024-04-03 17:00:00","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":36112,"visible":true,"origin":"","legend":"\u003cp\u003eThe flow diagram of this study\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4177324/v1/c575d0fe82de40b0d0357127.png"},{"id":54037058,"identity":"736111be-dd52-4601-a1f9-940c15fa2c43","added_by":"auto","created_at":"2024-04-03 17:08:00","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":16226,"visible":true,"origin":"","legend":"\u003cp\u003eThe Kaplan-Meier curve for non atrial fibrillation and atrial fibrillation\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-4177324/v1/62722efe51bf8dd0f8cc54a7.png"},{"id":54035736,"identity":"cef023c0-140b-4208-bd78-0d2bb59556d7","added_by":"auto","created_at":"2024-04-03 17:00:00","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":19046,"visible":true,"origin":"","legend":"\u003cp\u003eThe Kaplan-Meier curve for non atrial fibrillation, paroxysmal atrial fibrillation and permanent atrial fibrillation\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-4177324/v1/d03bc944897df74dec2f231e.png"},{"id":54035739,"identity":"b697f957-06bc-469a-a616-1a7763206a5d","added_by":"auto","created_at":"2024-04-03 17:00:01","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":15771,"visible":true,"origin":"","legend":"\u003cp\u003eKaplan-Meier curve of perioperative hyponatremia in elderly patients with hip fracture and atrial fibrillation\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-4177324/v1/077a3ea7304421eb5c029f37.png"},{"id":54035737,"identity":"7f7edfb0-e76c-4638-b37b-9385acc3d6b3","added_by":"auto","created_at":"2024-04-03 17:00:00","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":15726,"visible":true,"origin":"","legend":"\u003cp\u003eKaplan-Meier curve of perioperative pulmonary infection in elderly patients with hip fracture and atrial fibrillation\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-4177324/v1/a0f5bc58b37957b1f30ce9d9.png"},{"id":54035740,"identity":"9eaa066c-d3de-443f-a0eb-befd7c88f1fe","added_by":"auto","created_at":"2024-04-03 17:00:01","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":49377,"visible":true,"origin":"","legend":"\u003cp\u003eThe forest map of risk factors for all-cause mortality in patients with AF\u003c/p\u003e","description":"","filename":"6.png","url":"https://assets-eu.researchsquare.com/files/rs-4177324/v1/8b0cbfc2e403717edebea01c.png"},{"id":73093221,"identity":"6cbb5371-9894-4da2-a0f7-c5a19ed31db4","added_by":"auto","created_at":"2025-01-06 16:11:05","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1097219,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4177324/v1/04064faf-d93f-40cf-8c66-abd4374ffb6b.pdf"},{"id":54035738,"identity":"e7c9c58b-95b3-412e-bce1-a80c592050b1","added_by":"auto","created_at":"2024-04-03 17:00:00","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":233072,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementarymaterial.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4177324/v1/4f9fbe3144b3e087bf0715cd.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Predictors and Prognosis in Perioperative Complications and Survival among Elderly Hip Fracture Patients with Paroxysmal or Permanent Atrial Fibrillation: a nested case–control study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe prevalence of AF (atrial fibrillation) is not only widespread, but also a major complication following surgery for numerous patients [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], and is associated with poor outcomes, with incidence rates ranging from 2\u0026ndash;60%[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. and its outcomes are often unsatisfactory. The health and economic burden of AF has now reached an epidemic level [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. As the population continues to age, the number of people aged 60 and over will reach 2\u0026nbsp;billion by 2050[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], Research has demonstrated a steady rise in AF prevalence and mortality[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. and a correlation between AF and the risk of fractures [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe number of hip fractures is increasing as the world's population ages, Mortality and dysfunction associated with hip fracture in elderly adults represent a significant burden to society[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Surgery has now become the preferred way to treat hip fractures[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Among patients who underwent hip fracture surgery, 1-year mortality and 1-year readmission rates are reported to be higher in those with perioperative AF[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. According to one report, 80% would rather die than be hospitalized after breaking the hip, therefore, the most important task for older people is the prevention of hip fractures[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe occurrence of AF is very bad for patients because atrial fibrillation can be the cause of heart failure and blood circulation problems, which can increase the risk of ischemia, thrombosis, stroke and other serious consequences[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. AF is associated with an increased risk of heart failure, heart attack and stroke, thromboembolism, stroke, dementia, and overall mortality[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Additionally, hypertension and chronic obstructive pulmonary disease have been identified as other risk factors associated with perioperative AF[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIt has been shown that all-cause mortality at 10 years is 30.3% after a first electrocardiographic diagnosis of paroxysmal AF[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Palpitations and chest pain are more common in patients with paroxysmal AF[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], and are much more likely to be suitable for a rhythm control strategy, a much more complicated undertaking[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. In patients with permanent AF, the predominant symptom is dyspnoea[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], and there is an increased likelihood that they will die[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe prognosis for complications and long-term mortality in hip surgery patients with paroxysmal and permanent AF is currently uncertain, and the risk factors for paroxysmal AF in perioperative hip fracture remain largely unknown. This article seeks to identify the predictors and prognosis of elderly hip fractures related to perioperative AF (both paroxysmal AF and permanent AF). However, investigating the predictors of permanent AF poses a challenge. Our ultimate objective is to investigate the prognosis of both paroxysmal and permanent AF, as well as the factors that predict perioperative paroxysmal AF.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003ePatients and groups\u003c/h2\u003e \u003cp\u003e A retrospective study of hip fracture patients aged 65 or above, who were admitted to Hebei Medical University's Third Hospital from January 2018 to October 2020, was sanctioned by the Institutional Review Board. Furthermore, the Third Hospital granted a waiver for informed consent. People aged 65 and over who had a hip fracture, were willing to participate voluntarily, and had normal communication and comprehension skills were included in this study. Conversely, those with a pathological fracture, multiple fractures or old fractures, incomplete clinical data and those without surgery were excluded. In compliance with European Society of Cardiology (ESC) guidelines[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], three groups were identified for the study: (1) those without AF, (2) those with paroxysmal AF, and (3) those with permanent AF. Those with pathological fractures, multiple fractures, or old fractures, incomplete clinical data, and those without surgery were excluded. All AF patients were diagnosed accordingly.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eData collection\u003c/h2\u003e \u003cp\u003eDemographics, including age, gender, comorbidities (hypertension, coronary heart disease, diabetes, COPD, cancer, stroke), prognostic indicators (pulmonary infection, heart failure, stress ulcer, urinary tract infection, stress hyperglycemia, anemia, acute atrial fibrillation, acute cerebrovascular disease, hyponatremia, hypokalemia, hypoproteinemia), length of stay, and all-cause mortality, were all collected. Signs like hip fracture, anesthesia, and surgery type were also noted. Patients were followed from discharge until 1 October 2022, during which time their relatives were notified of their death by telephone.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eDefinition\u003c/h2\u003e \u003cp\u003e Classifying AF types into paroxysmal and permanent, we followed the European Society of Cardiology's guidelines. Paroxysmal AF was determined to be a self-terminating condition that lasted no longer than 7 days, and our diagnosis of it was mainly based on ECG monitoring and electrocardiogram. Permanent AF, on the other hand, was defined as AF in which cardioversion therapy either failed or was not attempted. We diagnose permanent atrial fibrillation by asking medical history[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eThe Shapiro-Wilk test was employed to assess the regularity of the continuous variables. Generally distributed variables were represented as the mean and standard deviation (SD); if not, they were shown as the median and interquartile range. Categorical variables were depicted as figures and percentages. A Mann-Whitney U test or Student's t-test was employed to contrast the differences between groups for continuous variables as suitable, while the Chi-square or Fisher exact test was utilized for categorical variables. To ascertain independent risk factors for paroxysmal AF in elderly patients with hip fractures, univariate and multivariate Logistic regression analysis was conducted. The Kaplan-Meier method was used to estimate the survival. Using SPSS statistical software (version 25.0) and GraphPad Prism software (version 9.0), Cox proportional hazards regression model was utilized to conduct both univariate and multivariate analyses of survival outcomes, with the level of significance set at P\u0026thinsp;\u0026lt;\u0026thinsp;0.05, in order to identify independent prognostic factors.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eDemographic characteristics\u003c/h2\u003e \u003cp\u003eBetween January 2018 and October 2020, a total of 1873 patients over the age of 65 years were admitted to our department for a hip fracture. Specifically, among them, 497 patients were excluded and 1376 cases remained in the final analysis. 148 patients had old fractures or pathological fractures; 76 patients had multiple fractures; and 95 patients had incomplete data; 178 patients received non-surgical treatment. Among them, 1189 patients had non-AF patients, 103 patients were paroxysmal AF and 84 patients had permanent AF. (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003ePatient characteristics at baseline\u003c/h2\u003e \u003cp\u003eThe characteristics of the three groups of patients, including age, gender, fracture type, complications, surgery type, and anesthesia, were outlined in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e in terms of basic characteristics. The characteristics of the 1376 patients were presented. Of the patients, 70.3% were female, and the average age was 79.51 years. People aged over 75 (72.5%) made up the largest proportion of these participants.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline characteristics of geriatric patients with hip fracture\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;1376)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNAF\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;1189)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAF\u003c/p\u003e \u003cp\u003e\u003c/p\u003e \u003cp\u003ePar AF\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;103)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;187)\u003c/p\u003e \u003cp\u003ePer AF\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;84)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e79.51\u0026thinsp;\u0026plusmn;\u0026thinsp;7.346\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e79.29\u0026thinsp;\u0026plusmn;\u0026thinsp;7.419\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e82.17\u0026thinsp;\u0026plusmn;\u0026thinsp;6.790\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e79.44\u0026thinsp;\u0026plusmn;\u0026thinsp;6.335\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge group, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;75 years\u003c/p\u003e \u003cp\u003e\u0026ge;\u0026thinsp;75 years\u003c/p\u003e \u003cp\u003eACCI(IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e379(27.5%)\u003c/p\u003e \u003cp\u003e997(72.5%)\u003c/p\u003e \u003cp\u003e5(4\u0026ndash;5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e344(28.9%)\u003c/p\u003e \u003cp\u003e845(71.1%)\u003c/p\u003e \u003cp\u003e5(4\u0026ndash;5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17(16.5%)\u003c/p\u003e \u003cp\u003e86(83.5%)\u003c/p\u003e \u003cp\u003e6(4\u0026ndash;6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18(21.4%)\u003c/p\u003e \u003cp\u003e66(78.6%)\u003c/p\u003e \u003cp\u003e5(4\u0026ndash;6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e408(29.7%)\u003c/p\u003e \u003cp\u003e968(70.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e348(29.3%)\u003c/p\u003e \u003cp\u003e841(70.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36(35.0%)\u003c/p\u003e \u003cp\u003e67(65.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e24(28.6%)\u003c/p\u003e \u003cp\u003e60(71.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFracture types, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemoral neck fractures\u003c/p\u003e \u003cp\u003eIntertrochanteric fractures\u003c/p\u003e \u003cp\u003eComorbidities, n (%)\u003c/p\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003cp\u003eStroke\u003c/p\u003e \u003cp\u003eCoronary heart disease\u003c/p\u003e \u003cp\u003eDiabetes\u003c/p\u003e \u003cp\u003eCOPD\u003c/p\u003e \u003cp\u003eCancer\u003c/p\u003e \u003cp\u003eSurgical type, n (%)\u003c/p\u003e \u003cp\u003eReplacement\u003c/p\u003e \u003cp\u003eFixation\u003c/p\u003e \u003cp\u003eAnesthesia type, n (%)\u003c/p\u003e \u003cp\u003eGeneral\u003c/p\u003e \u003cp\u003eLumbar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e648(47.1%)\u003c/p\u003e \u003cp\u003e728(52.9%)\u003c/p\u003e \u003cp\u003e664(48.3%)\u003c/p\u003e \u003cp\u003e540(39.2%)\u003c/p\u003e \u003cp\u003e368(26.7%)\u003c/p\u003e \u003cp\u003e300(21.8%)\u003c/p\u003e \u003cp\u003e47(3.4%)\u003c/p\u003e \u003cp\u003e62(4.5%)\u003c/p\u003e \u003cp\u003e586(42.6%)\u003c/p\u003e \u003cp\u003e790(57.4%)\u003c/p\u003e \u003cp\u003e792(57.6%)\u003c/p\u003e \u003cp\u003e584(42.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e556(46.8%)\u003c/p\u003e \u003cp\u003e633(53.2%)\u003c/p\u003e \u003cp\u003e538(45.2%)\u003c/p\u003e \u003cp\u003e446(37.5%)\u003c/p\u003e \u003cp\u003e294(24.7%)\u003c/p\u003e \u003cp\u003e254(21.4%)\u003c/p\u003e \u003cp\u003e28(2.4%)\u003c/p\u003e \u003cp\u003e53(4.5%)\u003c/p\u003e \u003cp\u003e503(42.3%)\u003c/p\u003e \u003cp\u003e686(57.7%)\u003c/p\u003e \u003cp\u003e686(57.7%)\u003c/p\u003e \u003cp\u003e503(42.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e58(56.3%)\u003c/p\u003e \u003cp\u003e45(43.7%)\u003c/p\u003e \u003cp\u003e69(67.0%)\u003c/p\u003e \u003cp\u003e49(47.6%)\u003c/p\u003e \u003cp\u003e47(45.6%)\u003c/p\u003e \u003cp\u003e18(17.5%)\u003c/p\u003e \u003cp\u003e15(14.6%)\u003c/p\u003e \u003cp\u003e5(4.9%)\u003c/p\u003e \u003cp\u003e52(50.5%)\u003c/p\u003e \u003cp\u003e51(49.5%)\u003c/p\u003e \u003cp\u003e57(55.3%)\u003c/p\u003e \u003cp\u003e46(44.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e34(40.5%)\u003c/p\u003e \u003cp\u003e50(59.5%)\u003c/p\u003e \u003cp\u003e57(67.9%)\u003c/p\u003e \u003cp\u003e45(53.6%)\u003c/p\u003e \u003cp\u003e27(32.1%)\u003c/p\u003e \u003cp\u003e28(33.3%)\u003c/p\u003e \u003cp\u003e10(11.9%)\u003c/p\u003e \u003cp\u003e4(4.8%)\u003c/p\u003e \u003cp\u003e31(36.9%)\u003c/p\u003e \u003cp\u003e53(63.1%)\u003c/p\u003e \u003cp\u003e49(58.3%)\u003c/p\u003e \u003cp\u003e35(41.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eValues are presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation, median (interquartile range), or number (percentage) as appropriate\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eSD Standard deviation, AF Atrial fibrillation, NAF Non atrial fibrillation, Par AF Paroxysmal atrial fibrillation, Per AF Permanent atrial fibrillation, COPD Chronic obstructive pulmonary disease, ACCI Age-Adjusted Charlson Comorbidity Index\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eComparison of the outcomes of patients with NAF and AF in elderly patients with hip fracture\u003c/b\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e described the outcomes for the three groups, including complications, length of stay and overall mortality. Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e showed the impact of perioperative complications, length of stay and all-cause mortality in elderly patients with a hip fracture. The incidence of pulmonary infection, heart failure, stress ulcer, urinary tract infection, acute cerebrovascular disease, hypokalemia, length of stay, and all-cause mortality was higher in those without AF, which was statistically significant (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). However, there was no significant difference in the anemia, stress hyperglycemia, hypoproteinemia and hypokalemia between the two groups. We also found that anemia and hypoproteinemia were the most common complications in both groups. At the end of the research, the permanent AF cohort had 38 fatalities (20.3%) as demonstrated by the Kaplan-Meier survival curve (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e), which was greater (log rank p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) than the non-AF group (8.7%) and the paroxysmal AF group (13.5%). Furthermore, fatalities (29.8%) in the permanent AF cohort were higher than those in the paroxysmal AF group and the non-AF group, as demonstrated by the Kaplan-Meier survival curve (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e) (Log Rank p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). And the Kaplan-Meier survival curve (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e) showed that perioperative mortality from hyponatremia was higher in elderly patients with hip fracture and atrial fibrillation (29.8%) than in the non hyponatremia group (Log Rank p\u0026thinsp;=\u0026thinsp;0.01).In addition, the Kaplan-Meier survival curve (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e) showed that perioperative mortality from pulmonary infection was higher in elderly patients with hip fracture and atrial fibrillation (29.8%) than in the non pulmonary infection group (Log Rank p\u0026thinsp;=\u0026thinsp;0.005).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of the outcomes of patients with non- atrial fibrillation paroxysmal atrial fibrillation and permanent atrial fibrillation in elderly patients with hip fracture\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;1376)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNAF\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;1189)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAF\u003c/p\u003e \u003cp\u003e\u003c/p\u003e \u003cp\u003ePar AF\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;103)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;187)\u003c/p\u003e \u003cp\u003ePer AF\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;84)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePulmonary infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e204(14.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e162(13.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e21(20.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e21(25.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeart failure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e421(30.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e329(27.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e44(42.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e48(57.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStress ulcer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25(1.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9(0.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7(6.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e9(10.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrinary tract infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e49(3.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33(2.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8(7.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e8(9.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e648(47.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e553(46.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e51(49.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e44(52.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStress hyperglycemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e52(3.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e45(3.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3(2.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4(4.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAcute cerebrovascular disease\u003c/p\u003e \u003cp\u003eHyponatremia\u003c/p\u003e \u003cp\u003eHypokalemia\u003c/p\u003e \u003cp\u003eHypoalbuminemia\u003c/p\u003e \u003cp\u003eHospital stay (IQR), days\u003c/p\u003e \u003cp\u003eAll-cause mortality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e51(3.7%)\u003c/p\u003e \u003cp\u003e421(30.6%)\u003c/p\u003e \u003cp\u003e325(23.6%)\u003c/p\u003e \u003cp\u003e700(50.9%)\u003c/p\u003e \u003cp\u003e12(10,16)\u003c/p\u003e \u003cp\u003e141(10.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16(1.3%)\u003c/p\u003e \u003cp\u003e359(30.2%)\u003c/p\u003e \u003cp\u003e261(22.0%)\u003c/p\u003e \u003cp\u003e606(51.0%)\u003c/p\u003e \u003cp\u003e12(10,16)\u003c/p\u003e \u003cp\u003e103(8.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e17(16.5%)\u003c/p\u003e \u003cp\u003e38(36.9%)\u003c/p\u003e \u003cp\u003e45(43.7%)\u003c/p\u003e \u003cp\u003e55(53.4%)\u003c/p\u003e \u003cp\u003e13(10,17)\u003c/p\u003e \u003cp\u003e13(13.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e18(21.4%)\u003c/p\u003e \u003cp\u003e24(28.6%)\u003c/p\u003e \u003cp\u003e19(22.6%)\u003c/p\u003e \u003cp\u003e39(46.4%)\u003c/p\u003e \u003cp\u003e13(11,17)\u003c/p\u003e \u003cp\u003e25(29.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eValues are presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation, median (interquartile range), or number (percentage) as appropriate\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eAF Atrial fibrillation, NAF Non atrial fibrillation, Par AF Paroxysmal atrial fibrillation, Per AF Permanent atrial fibrillation\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of the outcome of patients with non- atrial fibrillation and atrial fibrillation in old patients with hip fracture\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;1376)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNAF\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;1189)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAF\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;187)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP值\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePulmonary infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e204(14.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e162(13.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e42(22.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeart failure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e421(30.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e329(27.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e92(49.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStress ulcer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25(1.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9(0.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16(8.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrinary tract infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e49(3.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33(2.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16(8.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e648(47.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e553(46.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e95(50.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.274\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStress hyperglycemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e52(3.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e45(3.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7(3.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.978\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAcute cerebrovascular disease\u003c/p\u003e \u003cp\u003eHyponatremia\u003c/p\u003e \u003cp\u003eHypokalemia\u003c/p\u003e \u003cp\u003eHypoalbuminemia\u003c/p\u003e \u003cp\u003eHospital stay (IQR), days\u003c/p\u003e \u003cp\u003eAll-cause mortality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e51(3.7%)\u003c/p\u003e \u003cp\u003e421(30.6%)\u003c/p\u003e \u003cp\u003e325(23.6%)\u003c/p\u003e \u003cp\u003e700(50.9%)\u003c/p\u003e \u003cp\u003e12(10,16)\u003c/p\u003e \u003cp\u003e141(10.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16(1.3%)\u003c/p\u003e \u003cp\u003e359(30.2%)\u003c/p\u003e \u003cp\u003e261(22.0%)\u003c/p\u003e \u003cp\u003e606(51.0%)\u003c/p\u003e \u003cp\u003e12(10,16)\u003c/p\u003e \u003cp\u003e103(8.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e35(18.7%)\u003c/p\u003e \u003cp\u003e62(33.2%)\u003c/p\u003e \u003cp\u003e64(34.2%)\u003c/p\u003e \u003cp\u003e94(50.3%)\u003c/p\u003e \u003cp\u003e13(10,17)\u003c/p\u003e \u003cp\u003e38(20.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003cp\u003e0.414\u003c/p\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003cp\u003e0.859\u003c/p\u003e \u003cp\u003e0.010\u003c/p\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eValues are presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation, median (interquartile range), or number (percentage) as appropriate\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eAF Atrial fibrillation, NAF Non atrial fibrillation, Par AF Paroxysmal atrial fibrillation, Per AF Permanent atrial fibrillation\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eClinical variables predicting all-cause mortality in patients with AF\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e described the relationship between all-cause mortality and relevant clinical variables in elderly AF patients with hip fracture. Univariate COX analysis showed that age over 75 years, permanent AF, pulmonary infection, stress ulcer, heart failure, and hyponatremia were also associated with all-cause mortality (p \u0026lt;0.05). The multivariate COX proportional risk model incorporated the factors chosen from the univariate COX regression analysis. Because stress ulcers were rare and accidental, so they were not introduced. Independent risk factors for all-cause mortality in patients identified by multivariate COX proportional risk model, which included age over 75 (HR 2.990,95%CI 0.909\u0026ndash;9.836, P\u0026thinsp;=\u0026thinsp;0.071), permanent AF (HR 2.806, 95%CI 1.036\u0026ndash;4.198, P\u0026thinsp;=\u0026thinsp;0.039), pulmonary infection (HR 2.006,95%CI 1.019\u0026ndash;3.949, P\u0026thinsp;=\u0026thinsp;0.044), hyponatremia (HR 2.417,95%CI 1.177\u0026ndash;4.961, P\u0026thinsp;=\u0026thinsp;0.016). A forest plot was employed to illustrate the risk factors that foretold all-cause mortality in AHF patients, as depicted in Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCox proportional risk regression model for overall survival in patients with atrial fibrillation\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVaribles\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnivariate\u003c/p\u003e \u003cp\u003eHR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMultivariate\u003c/p\u003e \u003cp\u003eHR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u0026thinsp;\u0026ge;\u0026thinsp;75\u003c/p\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.180(0.997\u0026ndash;10.348)\u003c/p\u003e \u003cp\u003e1.615(0.764\u0026ndash;3.414)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.055\u003c/b\u003e\u003c/p\u003e \u003cp\u003e0.210\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.990(0.909\u0026ndash;9.836)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.071\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFracture types\u003c/p\u003e \u003cp\u003ePermanent AF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.801(0.921\u0026ndash;3.522)\u003c/p\u003e \u003cp\u003e2.140(1.093\u0026ndash;4.193)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.085\u003c/p\u003e \u003cp\u003e\u003cb\u003e0.027\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.806(1.036\u0026ndash;4.198)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.039\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePulmonary infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.495(1.287\u0026ndash;4.835)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.007\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.006(1.019\u0026ndash;3.949)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.044\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeart failure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.033(1.051\u0026ndash;3.934)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.035\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.999(0.467\u0026ndash;2.139)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.998\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStress ulcer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.238(1.421\u0026ndash;7.380)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.005\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.646(1.091\u0026ndash;6.416)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.031\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrinary tract infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.292(0.040\u0026ndash;2.130)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.225\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.433(0.752\u0026ndash;2.730)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.274\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStress hyperglycemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.980(0.472\u0026ndash;8.311)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.351\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAcute cerebrovascular disease\u003c/p\u003e \u003cp\u003eSurgical type\u003c/p\u003e \u003cp\u003eAnesthesia type\u003c/p\u003e \u003cp\u003eHyponatremia\u003c/p\u003e \u003cp\u003eHypokalemia\u003c/p\u003e \u003cp\u003eHypoalbuminemia\u003c/p\u003e \u003cp\u003eHospital stay (IQR), days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.891(0.372\u0026ndash;2.133)\u003c/p\u003e \u003cp\u003e1.685(0.850\u0026ndash;3.341)\u003c/p\u003e \u003cp\u003e0.567(0.289\u0026ndash;1.111)\u003c/p\u003e \u003cp\u003e2.275(1.199\u0026ndash;4.317)\u003c/p\u003e \u003cp\u003e1.483(0.772\u0026ndash;2.848)\u003c/p\u003e \u003cp\u003e1.473(0.773\u0026ndash;2.807)\u003c/p\u003e \u003cp\u003e0.987(0.929\u0026ndash;1.049)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.796\u003c/p\u003e \u003cp\u003e0.135\u003c/p\u003e \u003cp\u003e0.098\u003c/p\u003e \u003cp\u003e\u003cb\u003e0.012\u003c/b\u003e\u003c/p\u003e \u003cp\u003e0.236\u003c/p\u003e \u003cp\u003e0.239\u003c/p\u003e \u003cp\u003e0.675\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.417(1.177\u0026ndash;4.961)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.016\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eHypokalemia\u0026thinsp;=\u0026thinsp;potassium level\u0026thinsp;\u0026lt;\u0026thinsp;3.5 mmol/L. Hyponatremia\u0026thinsp;=\u0026thinsp;sodium level\u0026lt;135 mmol/L, Hypoalbuminemia\u0026thinsp;=\u0026thinsp;albumin level\u0026lt;35g/L\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eAbbreviations: HR Hazard ratio, CI Confidence interval\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eNon AF and paroxysmal AF Patient characteristics at baseline\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e summarized the characteristics of the hip fracture patients with NAF and paroxysmal AF. Most patients were women (70.3%), and the top four comorbidities were hypertension (47.0%), stroke (38.3%), coronary heart disease (26.4%), and COPD (3.3%). No distinctions between genders were observed between the groups, yet age was distinct; paroxysmal AF patients were older than NAF patients (82.17\u0026thinsp;\u0026plusmn;\u0026thinsp;6.790 years for paroxysmal AF, 79.29\u0026thinsp;\u0026plusmn;\u0026thinsp;7.419 years for NAF, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The burden of chronic diseases, as assessed by the age-adjusted Charlson Comorbidity Index (ACCI), was higher in patients with paroxysmal AF than in those with NAF (5(4\u0026ndash;5) versus 6(4\u0026ndash;6), p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Statistically, a significant distinction was observed between those with a history of hypertension, stroke, COPD, and coronary heart disease (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Despite the fact that those with paroxysmal atrial fibrillation appeared to have a greater prevalence of diabetes and cancer, no noteworthy disparity was discovered. Additionally, age\u0026thinsp;\u0026ge;\u0026thinsp;75 was found to be significantly higher among patients with paroxysmal AF.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline characteristics of geriatric hip fracture patients with non-atrial fibrillation and paroxysmal atrial fibrillation\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;1292)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNAF\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;1189)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePar AF\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;103)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eF/t/z\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP值\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e79.51\u0026thinsp;\u0026plusmn;\u0026thinsp;7.409\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e79.29\u0026thinsp;\u0026plusmn;\u0026thinsp;7.419\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e82.17\u0026thinsp;\u0026plusmn;\u0026thinsp;6.790\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.804\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge group, n (%)\u003c/p\u003e \u003cp\u003e\u0026lt;\u0026thinsp;75 years\u003c/p\u003e \u003cp\u003e\u0026ge;\u0026thinsp;75 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e361(27.9%)\u003c/p\u003e \u003cp\u003e931(72.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e344(28.9%)\u003c/p\u003e \u003cp\u003e845(71.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17(16.5%)\u003c/p\u003e \u003cp\u003e86(83.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.270\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.007\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003cp\u003eFemale\u003c/p\u003e \u003cp\u003eACCI\u003c/p\u003e \u003cp\u003eFracture types, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e384(29.7%)\u003c/p\u003e \u003cp\u003e908(70.3%)\u003c/p\u003e \u003cp\u003e5(4\u0026ndash;5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e348(29.3%)\u003c/p\u003e \u003cp\u003e841(70.7%)\u003c/p\u003e \u003cp\u003e5(4\u0026ndash;5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36(35.0%)\u003c/p\u003e \u003cp\u003e67(65.0%)\u003c/p\u003e \u003cp\u003e6(4\u0026ndash;6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.466\u003c/p\u003e \u003cp\u003e7.259\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.226\u003c/p\u003e \u003cp\u003e\u003cb\u003e\u0026lt;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemoral neck fractures\u003c/p\u003e \u003cp\u003eIntertrochanteric fractures\u003c/p\u003e \u003cp\u003eComorbidities, n (%)\u003c/p\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003cp\u003eStroke\u003c/p\u003e \u003cp\u003eCoronary heart disease\u003c/p\u003e \u003cp\u003eDiabetes\u003c/p\u003e \u003cp\u003eCOPD\u003c/p\u003e \u003cp\u003eCancer\u003c/p\u003e \u003cp\u003eSurgical type, n (%)\u003c/p\u003e \u003cp\u003eReplacement\u003c/p\u003e \u003cp\u003eFixation\u003c/p\u003e \u003cp\u003eAnesthesia type, n (%)\u003c/p\u003e \u003cp\u003eGeneral\u003c/p\u003e \u003cp\u003eLumbar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e614(47.5%)\u003c/p\u003e \u003cp\u003e678(52.5%)\u003c/p\u003e \u003cp\u003e607(47.0%)\u003c/p\u003e \u003cp\u003e495(38.3%)\u003c/p\u003e \u003cp\u003e341(26.4%)\u003c/p\u003e \u003cp\u003e272(21.1%)\u003c/p\u003e \u003cp\u003e43(3.3%)\u003c/p\u003e \u003cp\u003e58(4.5%)\u003c/p\u003e \u003cp\u003e555(43.0%)\u003c/p\u003e \u003cp\u003e737(57.0%)\u003c/p\u003e \u003cp\u003e743(57.5%)\u003c/p\u003e \u003cp\u003e549(42.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e556(46.8%)\u003c/p\u003e \u003cp\u003e633(53.2%)\u003c/p\u003e \u003cp\u003e538(45.2%)\u003c/p\u003e \u003cp\u003e446(37.5%)\u003c/p\u003e \u003cp\u003e294(24.7%)\u003c/p\u003e \u003cp\u003e254(21.4%)\u003c/p\u003e \u003cp\u003e28(2.4%)\u003c/p\u003e \u003cp\u003e53(4.5%)\u003c/p\u003e \u003cp\u003e503(42.3%)\u003c/p\u003e \u003cp\u003e686(57.7%)\u003c/p\u003e \u003cp\u003e686(57.7%)\u003c/p\u003e \u003cp\u003e503(42.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e58(56.3%)\u003c/p\u003e \u003cp\u003e45(43.7%)\u003c/p\u003e \u003cp\u003e69(67.0%)\u003c/p\u003e \u003cp\u003e49(47.6%)\u003c/p\u003e \u003cp\u003e47(45.6%)\u003c/p\u003e \u003cp\u003e18(17.5%)\u003c/p\u003e \u003cp\u003e15(14.6%)\u003c/p\u003e \u003cp\u003e5(4.9%)\u003c/p\u003e \u003cp\u003e52(50.5%)\u003c/p\u003e \u003cp\u003e51(49.5%)\u003c/p\u003e \u003cp\u003e57(55.3%)\u003c/p\u003e \u003cp\u003e46(44.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.466\u003c/p\u003e \u003cp\u003e17.989\u003c/p\u003e \u003cp\u003e4.061\u003c/p\u003e \u003cp\u003e21.322\u003c/p\u003e \u003cp\u003e0.862\u003c/p\u003e \u003cp\u003e43.909\u003c/p\u003e \u003cp\u003e0.035\u003c/p\u003e \u003cp\u003e2.589\u003c/p\u003e \u003cp\u003e0.215\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.063\u003c/p\u003e \u003cp\u003e\u003cb\u003e\u0026lt;0.001\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e0.044\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e\u0026lt;0.001\u003c/b\u003e\u003c/p\u003e \u003cp\u003e0.353\u003c/p\u003e \u003cp\u003e\u003cb\u003e\u0026lt;0.001\u003c/b\u003e\u003c/p\u003e \u003cp\u003e0.852\u003c/p\u003e \u003cp\u003e0.108\u003c/p\u003e \u003cp\u003e0.643\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eValues are presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation, median (interquartile range), or number (percentage) as appropriate\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eSD Standard deviation, AF Atrial fibrillation, NAF Non atrial fibrillation, Par AF Paroxysmal atrial fibrillation, Per AF Permanent atrial fibrillation, COPD Chronic obstructive pulmonary disease, ACCI Age-Adjusted Charlson Comorbidity Index\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eClinical variables predicting the appearance of paroxysmal AF\u003c/h2\u003e \u003cp\u003eUnivariate logistic analysis (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) revealed a correlation between age, ACCI, combined hypertension, stroke, coronary heart disease, and COPD and paroxysmal AF in elderly patients with hip fracture. Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e further demonstrated this association. To further investigate this, a multivariate logistic proportional hazards model was then implemented. Elderly patients with hip fracture who have combined hypertension (OR 2.248, 95% CI 1.415\u0026ndash;3.571, P\u0026thinsp;=\u0026thinsp;0.001), COPD (OR 4.694, 95% CI 2.207\u0026ndash;9.980,P\u0026lt;0.001), ACCI(OR 1.436, 95%CI 1.072\u0026ndash;1.924, P\u0026thinsp;=\u0026thinsp;0.015)were at an increased risk for perioperative .\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eUnivariate and multivariate Logistic regression analysis for factors associated with perioperative Paroxysmal AF in old patients with hip fracture\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVaribles\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnivariate\u003c/p\u003e \u003cp\u003eOR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMultivariate\u003c/p\u003e \u003cp\u003eOR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.056(1.026\u0026ndash;1.086)\u003c/p\u003e \u003cp\u003e0.770(0.504\u0026ndash;1.177)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;0.001\u003c/b\u003e\u003c/p\u003e \u003cp\u003e0.227\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.031(0.992\u0026ndash;1.071)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.125\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFracture types\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.681(0.454\u0026ndash;1.022)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.064\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eACCI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.800(1.522\u0026ndash;2.128)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.436(1.072\u0026ndash;1.924)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.015\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.456(1.603\u0026ndash;3.761)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.248(1.415\u0026ndash;3.571)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStroke\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.512(1.009\u0026ndash;2.264)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.045\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.844(0.494\u0026ndash;1.442)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.535\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCoronary heart disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.555(1.696\u0026ndash;3.848)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.305(0.761\u0026ndash;2.236)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.333\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes\u003c/p\u003e \u003cp\u003eCOPD\u003c/p\u003e \u003cp\u003eCancer\u003c/p\u003e \u003cp\u003eSurgical type\u003c/p\u003e \u003cp\u003eAnesthesia type\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.780(0.460\u0026ndash;1.321)\u003c/p\u003e \u003cp\u003e7.068(3.640-13.723)\u003c/p\u003e \u003cp\u003e1.094(0.427\u0026ndash;2.799)\u003c/p\u003e \u003cp\u003e0.719(0.481\u0026ndash;1.076)\u003c/p\u003e \u003cp\u003e1.101(0.734\u0026ndash;1.650)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.354\u003c/p\u003e \u003cp\u003e\u003cb\u003e\u0026lt;0.001\u003c/b\u003e\u003c/p\u003e \u003cp\u003e0.852\u003c/p\u003e \u003cp\u003e0.109\u003c/p\u003e \u003cp\u003e0.643\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.694(2.207\u0026ndash;9.980)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eN 1292 (cases: 103, controls: 1189)\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eAbbreviations: OR Odds ratio, CI Confidence interval\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eCOPD Chronic obstructive pulmonary disease, ACCI Age-Adjusted Charlson Comorbidity Index\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eClinical outcomes\u003c/h2\u003e \u003cp\u003eOur ultimate goal was to investigate the prognosis of elderly hip fracture patients with both paroxysmal and permanent AF, as well as the prognosticators of elderly hip fracture patients with perioperative paroxysmal AF, with a prevalence of 7.5% in our group. Permanent AF had significantly more heart failure, all-cause mortality, and hypokalemia and hyponatremia complications than paroxysmal AF. In our cohort, elderly hip fracture patients with permanent atrial fibrillation had generally poorer outcomes than those with paroxysmal AF. Moreover, permanent AF was identified as a separate risk factor for all-cause mortality post-surgery, in addition to other baseline conditions and multiple comorbidities. Age, pulmonary infection, and hyponatremia were also independent risk factors for death in these patients. The incidence of hip fracture in elderly patients with paroxysmal AF was linked to ACCI, hypertension, and COPD.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eComparison with other studies\u003c/h2\u003e \u003cp\u003eAF, even in those without other TCVRFs (standard cerebrocardiovascular risk factors), is an independent hazard for stroke and all-cause cardiovascular mortality [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. AF and heart failure are two conditions that are often associated with each other, as AF facilitates HF to occur and vice-versa[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The cause of AF and heart failure may be a 25% decrease in cardiac ejection fraction, which in turn leads to a decrease in cardiac coronary perfusion. This, in turn, causes a decrease in coronary perfusion, and a decrease in the blood supply to the atria, thus resulting in an atrial heart rhythm disorder[\u003cspan additionalcitationids=\"CR21\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Patients with atrial fibrillation demonstrate a significantly greater incidence of stress ulcer than those without. It is thought to occur with an incidence of 0.2\u0026ndash;2% in the post-operative period, according to several reviews, although this is lower than many of the post-operative complications[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Our research reveals that those with atrial fibrillation have a significantly higher prevalence of hypokalemia than those without. In elderly adults with AF, this rate is 30.98% of the total. Hypokalemia has a strong association with death from cardiovascular causes[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. The incidence of acute cerebrovascular disease in patients with AF is significantly greater than in those without AF, and ischemic stroke or transient ischemic attack (TIA) is the first manifestation of AF in 2 to 5% of them, with a fivefold increased risk of stroke.[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWe find that in patients with AF, permanent AF is an independent indicator of mortality. The prevailing view is that permanent and persistent AF patterns are associated with poorer survival[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Amalia Baroutid's study revealed that, at a median follow-up of 31 months (interquartile range 10 to 52 months), 37.3% of patients perished. In comparison to those with paroxysmal AF, permanent AF patients had a higher mortality rate (adjusted hazard ratio (aHR),1.37; 95% confidence interval [CI],1.08\u0026ndash;1.74, P \u0026frac14;).009), but similar rates of CV mortality or hospitalization (aHR, 1.09; 95%CI, 0.91\u0026ndash;1.31, P \u0026frac14; .35)[\u003cspan additionalcitationids=\"CR29\" citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. This result is in line with our findings.\u003c/p\u003e \u003cp\u003ePulmonary infection is an independent indicator of AF mortality in those with hip fracture and AF. Pneumonia is a common complication of hip fracture and can increase mortality by up to four times[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Patients with pneumonia may cough, produce sputum, have difficulty breathing or have fever[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Though progress has been made in the production of antibiotics, mortality from pneumonia persists, particularly as the amount of high-risk patients has risen [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eA serum sodium concentration of less than 135 mEq/L is what defines hyponatremia, an electrolyte abnormality that is often seen in heart failure patients and has been linked to adverse results. Its prevalence ranges from 13.8\u0026ndash;33.7%. Hyponatremia is an independent predictive risk factor for death in hip fracture patients with comorbid AF, as confirmed by the study of Aydın Aky\u0026uuml;z et al[\u003cspan additionalcitationids=\"CR35\" citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eCharlson et al. created the Charlson Comorbidity Index, a tool for assessing the mortality risk due to comorbidities[\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. However, there is no research on the correlation between ACCI (age-adjusted Charlson Comorbidity Index) and perioperative AF in hip fracture patients. In our study, ACCI is identified as a significant predictor of perioperative AF in geriatric hip fracture patients. Hypertension and COPD have been identified as risk factors for perioperative AF associated with surgery [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. The results of Monika Gawałko et al are consistent with ours. Hypertension is prevalent in \u0026gt;\u0026thinsp;70% of patients with AF. Patients suffering from hypertension have a significantly greater chance of AF, potentially up to 73% higher in risk. Current guidelines recommend that systematic AF screening may be warranted in all patients aged\u0026thinsp;\u0026ge;\u0026thinsp;65 years with at least one cardiovascular disease, including hypertension.[\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eBoth AF and COPD are significant global contributors to health-care burden, and they frequently coexist due to their shared pathophysiology. A study utilizing the Spanish National Hospital Discharge Database discovered that COPD is a common comorbidity in patients hospitalized for AF[\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. In the Atherosclerosis Risk in Community (ARIC) cohort study [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e], COPD and reduced lung function have been independently linked to the emergence of AF, despite the presence of risk factors for cardiovascular disease (e.g. smoking) in many COPD patients that may be confounding factors.[\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. The co-existence of COPD and AF is a well established fact: Sidney et al. A cohort study of 45,966 patients was conducted retrospectively, with a case-control approach. They found a 4.41-fold increased risk of AF in COPD, something that was reproduced[\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. COPD triggers pathological processes including hypoxia, electrolyte imbalances and altered pulmonary hemodynamics. Oxidative stress and chronic systemic inflammation, resulting in hypoxia, increased expression of matrix metalloproteinases (MMPs) and atrial remodelling, can be the catalysts for the emergence of arrhythmia. In particular, COPD-induced atrial myocyte dysfunction and fibrosis are the cause of this (2010)[\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. Pulmonary hypertension and elevated pCO2 levels also result from hypoxia, are risk factors for AF, as is elevated systolic blood pressure[\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. Finally, COPD patients may have low serum potassium levels due to electrolyte disturbances caused by overuse of corticosteroids or beta-blockers. The p-wave's length is augmented, a hazard factor for AF, as a result of this.[\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eThis study is limited and needs to be interpreted. First of all, the study is a retrospective study and a single-center study. Secondly, because there are fewer patients with AF, there are differences in some outcomes.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eOur study shows that older hip fracture patients with AF have more complications and mortality than those without. Independent risk factors for death from AF include age, pneumonia and hyponatremia. Patients diagnosed with AF, particularly those with permanent AF, should prioritize the prevention and management of pulmonary infections and hyponatremia. Patients with hip fracture aged 75 and over are particularly prone to paroxysmal AF, with ACCI, hypertension, and COPD being identified as independent risk factors. Consequently, patients with this condition should focus on preventing paroxysmal AF.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAF \u0026nbsp; \u0026nbsp; \u0026nbsp; Atrial fibrillation\u003c/p\u003e\n\u003cp\u003eNAF \u0026nbsp; \u0026nbsp; Non atrial fibrillation\u003c/p\u003e\n\u003cp\u003ePar AF \u0026nbsp; Paroxysmal atrial fibrillation\u003c/p\u003e\n\u003cp\u003ePer AF \u0026nbsp; Permanent atrial fibrillation\u003c/p\u003e\n\u003cp\u003eCOPD \u0026nbsp; Chronic obstructive pulmonary disease\u003c/p\u003e\n\u003cp\u003eACCI \u0026nbsp; \u0026nbsp;Age-adjusted Charlson Comorbidity Index\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eZQ. W and ZY. H conceived the study. W. L, AY.M and W. Z supported study preparation and data collection. WN. L, SH.L, SD.R, QI.Y, MM,F and JK.K collected the data and drafted the manuscript. ZQ. W and ZY. H critically reviewed the manuscript for important intellectual content. All authors approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data supporting the findings of this study are available upon request from Zhi qian Wang.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe ethics committee of the Third Hospital of Hebei Medical University gave their approval to this study protocol, in accordance with the Helsinki Declaration (approval number 2021-087-1) and an exemption from obtaining informed consent was granted due to the retrospective nature of the data collection. To ensure patient privacy, all data was anonymized before analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e1 At the Third Hospital of Hebei Medical University, located in Shijiazhuang, Hebei, People\u0026apos;s Republic of China, lies the Department of Geriatric Orthopedics. The Third Hospital of Hebei Medical University also houses the Department of Ortho-paedic Surgery. Additionally, the NHC Key Laboratory of Intelligent Ortho-peadic Equipment is situated in the same hospital. Lastly, the Chinese Academy of Engineering is located in Beijing, People\u0026apos;s Republic of China.\u003c/p\u003e\n\u003cp\u003ePublisher’s Note\u003c/p\u003e\n\u003cp\u003eSpringer Nature remains neutral with regard to jurisdictional claims in pub-\u003c/p\u003e\n\u003cp\u003elished maps and institutional affiliations.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBhave, P.D., et al., \u003cem\u003eIncidence, predictors, and outcomes associated with postoperative atrial fibrillation after major noncardiac surgery.\u003c/em\u003e American Heart Journal, 2012. \u003cstrong\u003e164\u003c/strong\u003e(6): p. 918-924.\u003c/li\u003e\n\u003cli\u003eAlonso-Coello, P., et al., \u003cem\u003ePredictors, Prognosis, and Management of New Clinically Important Atrial Fibrillation After Noncardiac Surgery: A Prospective Cohort Study.\u003c/em\u003e Anesth Analg, 2017. \u003cstrong\u003e125\u003c/strong\u003e(1): p. 162-169.\u003c/li\u003e\n\u003cli\u003eLeibowitz, D., et al., \u003cem\u003ePerioperative atrial fibrillation is associated with increased one-year mortality in elderly patients after repair of hip fracture.\u003c/em\u003e Int J Cardiol, 2017. \u003cstrong\u003e227\u003c/strong\u003e: p. 58-60.\u003c/li\u003e\n\u003cli\u003eSairenchi, T., et al., \u003cem\u003eAtrial Fibrillation With and Without Cardiovascular Risk Factors and Stroke Mortality.\u003c/em\u003e Journal of Atherosclerosis and Thrombosis, 2021. \u003cstrong\u003e28\u003c/strong\u003e(3): p. 241-248.\u003c/li\u003e\n\u003cli\u003eBoe, D.M., L.A. 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An observational study using hospital discharge data in Spain (2004-2013).\u003c/em\u003e Int J Cardiol, 2017. \u003cstrong\u003e236\u003c/strong\u003e: p. 209-215.\u003c/li\u003e\n\u003cli\u003eLi, J., et al., \u003cem\u003eAirflow obstruction, lung function, and incidence of atrial fibrillation: the Atherosclerosis Risk in Communities (ARIC) study.\u003c/em\u003e Circulation, 2014. \u003cstrong\u003e129\u003c/strong\u003e(9): p. 971-80.\u003c/li\u003e\n\u003cli\u003eSidney, S., et al., \u003cem\u003eCOPD and incident cardiovascular disease hospitalizations and mortality: Kaiser Permanente Medical Care Program.\u003c/em\u003e Chest, 2005. \u003cstrong\u003e128\u003c/strong\u003e(4): p. 2068-75.\u003c/li\u003e\n\u003cli\u003eZhang, L., et al., \u003cem\u003eStructural changes in the progression of atrial fibrillation: potential role of glycogen and fibrosis as perpetuating factors.\u003c/em\u003e Int J Clin Exp Pathol, 2015. \u003cstrong\u003e8\u003c/strong\u003e(2): p. 1712-8.\u003c/li\u003e\n\u003cli\u003eTerzano, C., et al., \u003cem\u003eAtrial fibrillation in the acute, hypercapnic exacerbations of COPD.\u003c/em\u003e Eur Rev Med Pharmacol Sci, 2014. \u003cstrong\u003e18\u003c/strong\u003e(19): p. 2908-17.\u003c/li\u003e\n\u003cli\u003eKrijthe, B.P., et al., \u003cem\u003eSerum potassium levels and the risk of atrial fibrillation: the Rotterdam Study.\u003c/em\u003e Int J Cardiol, 2013. \u003cstrong\u003e168\u003c/strong\u003e(6): p. 5411-5.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Non- atrial fibrillation, Paroxysmal atrial fibrillation, Permanent atrial fibrillation, Hip fracture, Risk factors, Prognosis, Elderly","lastPublishedDoi":"10.21203/rs.3.rs-4177324/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4177324/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA dearth of data exists concerning atrial fibrillation (AF) during the perioperative stage of non-cardiothoracic surgery, particularly orthopaedic surgery. Therefore, given the frequency and significant impact of AF in the perioperative period. We need to make sure the prognosis of paroxysmal and permanent AF and the predictors of perioperative paroxysmal AF.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAn examination of hip fracture patients at the Third Hospital of Hebei Medical University, who had been hospitalized from January 2018 to October 2020 in succession, was conducted retrospectively. To determine independent risk factors for paroxysmal AF in elderly hip fracture patients, univariate and multivariate logistic regression analysis were employed. The Kaplan-Meier survival curve demonstrated the correlation between all-cause mortality in the non-AF, paroxysmal AF, and permanent AF groups. An assessment of the correlation between baseline factors, complications, and all-cause mortality was conducted through univariable and multivariable Cox proportional hazards analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEnrolling 1,376 elderly patients with hip fractures, we found 1,189 in the non-AF group, 103 in the paroxysmal AF group, and 84 in the permanent AF group. Of the 1376 patients, the majority were female (70.3%) with an average age of 79.51 years, and the majority of them were over 75 years of age (72.5%) - the majority.\u003c/p\u003e\n\u003cp\u003eKaplan-Meier plots revealed a significantly lower overall survival rate in elderly individuals suffering from hip fracture, as well as especially permanent AF. Based on our COX regression analysis, we found that the main risk factors for all-cause death in elderly patients with hip fracture combined with AF patients were concomitant pulmonary infection, hyponatremia, permanent AF and age.\u003c/p\u003e\n\u003cp\u003eElderly patients with hip fracture combined with paroxysmal AF group showed a higher incidence of perioperative complications, such as hypertension, COPD and ACCI were independent risk factors for paroxysmal AF in elderly patients with hip fracture.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe prevention of paroxysmal AF in elderly patients with hip fractures is of paramount importance. And avert complications and potential mortality also significant, elderly patients with hip fracture, particularly those with permanent AF, must be given suitable perioperative care to avert the risks of pulmonary infection and hyponatremia.\u003c/p\u003e","manuscriptTitle":"Predictors and Prognosis in Perioperative Complications and Survival among Elderly Hip Fracture Patients with Paroxysmal or Permanent Atrial Fibrillation: a nested case–control study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-03 16:59:56","doi":"10.21203/rs.3.rs-4177324/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-06-23T05:07:54+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-06-12T12:54:05+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"121369417399642308233724339665805607582","date":"2024-06-12T12:05:28+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-05-10T20:01:51+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-05-10T19:57:34+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-03-29T06:47:20+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-03-29T06:45:24+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Geriatrics","date":"2024-03-27T15:59:03+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5ec79665-74ce-4903-a159-813a14b9f819","owner":[],"postedDate":"April 3rd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-01-06T16:00:25+00:00","versionOfRecord":{"articleIdentity":"rs-4177324","link":"https://doi.org/10.1186/s12877-024-05647-1","journal":{"identity":"bmc-geriatrics","isVorOnly":false,"title":"BMC Geriatrics"},"publishedOn":"2025-01-03 15:57:14","publishedOnDateReadable":"January 3rd, 2025"},"versionCreatedAt":"2024-04-03 16:59:56","video":"","vorDoi":"10.1186/s12877-024-05647-1","vorDoiUrl":"https://doi.org/10.1186/s12877-024-05647-1","workflowStages":[]},"version":"v1","identity":"rs-4177324","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4177324","identity":"rs-4177324","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}