Incident and preexisting atrial fibrillation in heart failure patients increased the risk of death (HR 1.67 and 1.13) and HF hospitalization (HR 2.00 and 1.22) compared to patients without AF.
Cohort (n=23,644)
Yes
Does atrial fibrillation increase the risk of adverse outcomes (stroke, hospitalization, death) in patients with HF-PEF or HF-REF?
Atrial fibrillation, whether incident or preexisting, is a potent risk factor for stroke, hospitalization, and death in patients with both HFpEF and HFrEF.
Effect estimate: HR 1.67
BACKGROUND: Atrial fibrillation (AF) and heart failure (HF) are 2 of the most common cardiovascular conditions nationally and AF frequently complicates HF. We examined how AF has impacts on adverse outcomes in HF-PEF versus HF-REF within a large, contemporary cohort. METHODS AND RESULTS: We identified all adults diagnosed with HF-PEF or HF-REF based on hospital discharge and ambulatory visit diagnoses and relevant imaging results for 2005-2008 from 4 health plans in the Cardiovascular Research Network. Data on demographic features, diagnoses, procedures, outpatient pharmacy use, and laboratory results were ascertained from health plan databases. Hospitalizations for HF, stroke, and any reason were identified from hospital discharge and billing claims databases. Deaths were ascertained from health plan and state death files. Among 23 644 patients with HF, 11 429 (48.3%) had documented AF (9081 preexisting, 2348 incident). Compared with patients who did not have AF, patients with AF had higher adjusted rates of ischemic stroke (hazard ratio HR 2.47 for incident AF; HR 1.57 for preexisting AF), hospitalization for HF (HR 2.00 for incident AF; HR 1.22 for preexisting AF), all-cause hospitalization (HR 1.45 for incident AF; HR 1.15 for preexisting AF), and death (incident AF HR 1.67; preexisting AF HR 1.13). The associations of AF with these outcomes were similar for HF-PEF and HF-REF, with the exception of ischemic stroke. CONCLUSIONS: AF is a potent risk factor for adverse outcomes in patients with HF-PEF or HF-REF. Effective interventions are needed to improve the prognosis of these high-risk patients.
McManus et al. (2013) conducted a cohort in Heart Failure (HF-PEF and HF-REF) (n=23,644). Atrial Fibrillation (incident and preexisting) vs. No Atrial Fibrillation was evaluated on Ischemic stroke, hospitalization for HF, all-cause hospitalization, and death (HR 1.67). Incident and preexisting atrial fibrillation in heart failure patients increased the risk of death (HR 1.67 and 1.13) and HF hospitalization (HR 2.00 and 1.22) compared to patients without AF.