Atrial fibrillation was associated with increased mortality only in patients with HFpEF (HR 1.22; 95% CI 1.02-1.46) and increased stroke risk in those with HFrEF or HFpEF.
Cohort (n=5,414)
Yes
Does atrial fibrillation increase the risk of mortality and stroke in patients with heart failure across different ejection fraction categories?
Atrial fibrillation is increasingly prevalent with higher ejection fractions in heart failure and is associated with increased mortality specifically in HFpEF, as well as increased stroke risk in both HFrEF and HFpEF.
Effect estimate: HR 1.22 (95% CI 1.02-1.46)
Objective To determine the prognostic value of atrial fibrillation (AF) in patients with heart failure (HF) and preserved, mid-range or reduced ejection fraction (EF). Methods Patients hospitalised for acute HF were enrolled in the Korean Acute Heart Failure registry, a prospective, observational, multicentre cohort study, between March 2011 and February 2014. HF types were defined as reduced EF (HFrEF, LVEF <40%), mid-range EF (HFmrEF, LVEF 40%–49%) or preserved EF (HFpEF, LVEF ≥50%). Results Of 5414 patients enrolled, HFrEF, HFmrEF and HFpEF were seen in 3182 (58.8%), 875 (16.2%) and 1357 (25.1%) patients, respectively. The prevalence of AF significantly increased with increasing EF (HFrEF 28.9%, HFmrEF 39.8%, HFpEF 45.2%; p for trend <0.001). During follow-up (median, 4.03 years; IQR, 1.39–5.58 years), 2806 (51.8%) patients died. The adjusted HR of AF for all-cause death was 1.06 (0.93–1.21) in the HFrEF, 1.10 (0.87–1.39) in the HFmrEF and 1.22 (1.02–1.46) in the HFpEF groups. The HR for the composite of all-cause death or readmission was 0.97 (0.87–1.07), 1.14 (0.93–1.38) and 1.03 (0.88–1.19) in the HFrEF, HFmrEF and HFpEF groups, respectively, and the HR for stroke was 1.53 (1.03–2.29), 1.04 (0.57–1.91) and 1.90 (1.13–3.20), respectively. Similar results were observed after propensity score matching analysis. Conclusions AF was more common with increasing EF. AF was seen to be associated with increased mortality only in patients with HFpEF and was associated with an increased risk of stroke in patients with HFrEF or HFpEF. Trial registration number NCT01389843
Son et al. (2020) conducted a cohort in Acute heart failure (n=5,414). Atrial fibrillation vs. Without atrial fibrillation was evaluated on All-cause death (HR 1.22, 95% CI 1.02-1.46). Atrial fibrillation was associated with increased mortality only in patients with HFpEF (HR 1.22; 95% CI 1.02-1.46) and increased stroke risk in those with HFrEF or HFpEF.