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Abstract Background The prevalence of combined heart failure (HF) and atrial fibrillation (AF) is rising, and these patients suffer from high rates of mortality. This study aims to provide robust data on factors associated with death, uniquely supported by post-mortem examination. Methods A retrospective cohort study of hospitalized adults with a clinical diagnosis of HF and AF at a tertiary centre in Romania between 2014 and 2017. A standardized post-mortem examination was performed where death occurred within 24 h of admission, when the cause of death was not clear or by physician request. National records were used to collect mortality data, subsequently categorized and analysed as HF-related death, vascular death and non-cardiovascular death using Cox proportional hazards regression. Results A total of 1009 consecutive patients with a mean age of 73 ± 11 years, 47% women, NYHA class 3.0 ± 0.9, left ventricular ejection fraction (LVEF) 40.1 ± 11.0% and 100% anticoagulated were followed up for 1.5 ± 0.9 years. A total of 291 (29%) died, with post-mortems performed on 186 (64%). Baseline factors associated with mortality were dependent on the cause of death. HF-related death in 136 (47%) was associated with higher NYHA class (hazard ratio [HR] 2.45 per one class increase, 95% CI 1.73–3.46; p

This study presents a rare case of three synchronous colon tumors with metastasis to the left inguinal lymph node, challenging the conventional understanding of the metastatic pathways and highlighting the exceptional nature of such occurrences. This highlights the importance of considering alternative atypical metastatic routes for the management of colon cancer. A literature search was performed to identify similar cases. Our findings emphasize the need for broader diagnostic evaluations to detect atypical metastasis at early stages. Furthermore, this case highlights the need for potential refinements in follow-up and screening protocols to capture unusual patterns of cancer spread. This case encourages further research into innovative treatments tailored to the unique metastatic behaviors observed in synchronous colon tumors, with a view to improving outcomes in similar cases.