Heart involvement in alcohol use disorder: observational and retrospective study in a specialized hospital unit and long-term follow-up.

Although growing attention has been drawn to alcohol-related heart damage, several clinical aspects, including prevalence and outcome of alcoholic cardiomyopathy (ACM) and atrial fibrillation (AF) in patients with alcohol use disorder (AUD) remain elusive. This study investigated the clinical impact of ACM and AF on AUD patients in the setting of an internal medicine unit. We retrospectively analyzed 291 consecutive patients admitted for AUD at a single specialized center for AUD diagnosis and treatment, affiliated with an internal medicine unit. We included patients who underwent echocardiographic evaluation following hospital admission. Demographic data, comorbidities, alcohol-related organ damage, and ECG findings were collected to diagnose AF and ACM and to assess their clinical impact. Among 291 patients undergoing echocardiography and ECG, 239 were males (82.1%). They were categorized into patients with (n = 42, Group A) and without ACM (n = 249, Group B). The prevalence of ACM was 14.4%, whereas AF was found in 19.1%. ACM patients were asymptomatic in 28.6% of cases. Among comorbidities, significant differences were observed in the prevalence of type 2 diabetes (7.1% in Group A, 21.2% in Group B, p = 0.0329). Risk of mortality was significantly influenced by AF, but not by ACM. A significant proportion of AUD inpatients were diagnosed with ACM (about 14%, 95% men) and AF (19.1%, 88.9% men), which only affected mortality. Notably, more than a quarter of ACM patients were asymptomatic for heart failure supporting the value of echocardiographic assessment even when overt heart failure was absent. By survival analysis, AF rather than ACM emerged as an adverse prognostic factor. These findings support a structured cardiac evaluation in hospitalized patients with AUD.