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November 7, 2022European Journal of Heart FailureOpen Access

Intersection of Atrial Fibrillation and Heart Failure with Mildly Reduced and Preserved Ejection Fraction in 400 000 Participants in the Get With The Guidelines-Heart Failure Registry

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Why the study?

Although AF frequently coexists with HFpEF, few data are available evaluating AF-specific care patterns and post-discharge outcomes in patients hospitalized for HFpEF.

What are the AF-specific care patterns and post-discharge outcomes among patients hospitalized for HFmrEF or HFpEF, based on AF history?

Population

>400 000 participants hospitalized for HFmrEF or HFpEF in the Get With The Guidelines-Heart Failure Registry

Comparison

Patients with AF vs without AF history

Design

Registry-based cohort study

Key result

Comorbid atrial fibrillation in patients hospitalized for heart failure with mildly reduced or preserved ejection fraction was associated with a higher 12-month risk of all-cause mortality (35% vs 29%).

Authors

RPRavi B. PatelSGStephen J. GreeneHXHaolin Xu

Discussion

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Member takes

Overview

Comorbid AF signals higher post-discharge mortality in HFmrEF/HFpEF; leaves open whether intensified anticoagulation or rhythm control improves outcomes.

Study Design

Type

Cohort (n=429,464)

Multicenter

Yes

Structured PICO

What are the AF-specific care patterns and post-discharge outcomes among patients hospitalized for HFmrEF or HFpEF, based on AF history?

P
Population
>400,000 patients hospitalized for heart failure with mildly reduced ejection fraction (HFmrEF) or preserved ejection fraction (HFpEF) in the Get With The Guidelines-Heart Failure Registry
C
Comparator
Patients without a history of atrial fibrillation
O
Outcome
AF-specific medical therapies (anti-arrhythmic drugs, anticoagulants) and post-discharge outcomes (death and rehospitalization)hard clinical

Main Result

Absolute Event Rate: 35% vs 29%

p-value: p=<0.0001

In patients hospitalized with HFmrEF or HFpEF, comorbid AF is increasingly prevalent and associated with worse outcomes, yet the use of AF-specific therapies like anticoagulation and rhythm control remains modest.

Limitations

  • Ascertainment of AF was based upon case report forms without adjudicated electrocardiograms
  • AF type (paroxysmal, persistent, permanent) was not captured
  • Participation in GWTG-HF is voluntary, which may affect generalizability
  • Analyses of post-discharge outcomes and prescriptions were limited to Medicare Fee-for-Service beneficiaries
  • Dose of anti-arrhythmic drugs was not captured
  • Readmission data relied upon ICD coding and causes of hospitalizations were not independently adjudicated

Cite This Study

Patel et al. (2022) conducted a cohort in Heart failure with mildly reduced and preserved ejection fraction (n=429,464). Atrial fibrillation vs. No history of atrial fibrillation was evaluated on 12-month all-cause mortality (p=<0.0001). Comorbid atrial fibrillation in patients hospitalized for heart failure with mildly reduced or preserved ejection fraction was associated with a higher 12-month risk of all-cause mortality (35% vs 29%).

synapsesocial.com/papers/6a08814a9a6c4ba6e610abb8https://doi.org/10.1002/ejhf.2729
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Characterizing atrial fibrillation in patients with and without heart failure across the ejection fraction spectrum: Incidence, prevalence, and treatment strategies2024 · 8 citations
  2. 2Atrial fibrillation in chronic heart failure patients with reduced ejection fraction: The CHECK-HF registry2020 · 14 citations
  3. 3Atrial Fibrillation and Outcomes in Heart Failure With Preserved Versus Reduced Left Ventricular Ejection Fraction2013 · 138 citations
  4. 4Prognosis and treatment strategies for atrial fibrillation in heart failure with mildly reduced ejection fraction2024 · 8 citations
  5. 5The Role of Atrial Fibrillation among Patients with Chronic Heart Failure2020