Association of Heart Failure Subtypes and Atrial fibrillation: Data from the Atherosclerosis Risk in Communities (ARIC) Study

Aims To determine the prevalence and incidence of AF among HF subtypes in a biracial community-based cohort. Methods We studied 6,496 participants in the Atherosclerosis Risk in Community study (mean age, 75.8±5.3, 59% women, 23% black) who attended the 2011-2013 visit. HF was identified from physician adjudicated diagnosis, hospital discharges, and self-report. HF subtypes were based on echocardiography. A left ventricular ejection fraction <40% represents HF with reduced ejection fraction (HFrEF), 40%-49% for HF with midrange ejection fraction (HFmEF), and ≥50% for HF with preserved ejection fraction (HFpEF). AF was ascertained through 2017 from study electrocardiograms, hospital discharges, and death certificates. Confounder-adjusted logistic regression and Cox models were used to estimate associations of HF subtype with prevalent and incident AF. Results Among eligible participants, 393 had HF (HFpEF=232, HFmEF=41, HFrEF=35 and unclassified HF =85) and 735 had AF. Compared to those without HF, all HF subtypes were more likely to have prevalent AF [odds ratio (95% confidence interval (CI)) 7.4 (5.6-9.9) for HFpEF, 8.1 (4.3-15.3) for HFmEF, 10.0 (5.0-20.2) for HFrEF, 8.8 (5.6-14.0) for unclassified HF]. Among participants without AF at baseline (n=5,761), 610 of them developed AF. Prevalent HF was associated with increased risk of AF [hazard ratio (95%CI) 2.3 (1.6-3.3) for HFpEF, 4.6 (2.4-8.6) for HFmEF, 3.8 (1.8-8.2) for HFrEF, 2.3 (0.9-5.6) for unclassified HR]. Conclusion AF and HF frequently co-occur, with small differences by HF subtype, underscoring the importance of understanding the interplay of these two epidemics and evaluating shared preventive and therapeutic strategies.