Key result
Atrial fibrillation independently predicted 1-year all-cause mortality in heart failure outpatients aged ≤65 years (HR 1.42; 95% CI 1.10-1.81) and 66-75 years, but not in those >75 years.
Why the study?
Does atrial fibrillation predict 1-year all-cause mortality differently across age groups in outpatients with chronic heart failure?
Cohort (n=8,178)
Yes
Does atrial fibrillation predict 1-year all-cause mortality differently across age groups in outpatients with chronic heart failure?
Atrial fibrillation is an independent predictor of 1-year mortality in heart failure patients aged 75 years or younger, but loses its independent prognostic value in older patients.
Answers are grounded in this paper and cite their sources.
May inform age-specific risk stratification in HF outpatients; leaves open causality and need for prospective validation.
OBJECTIVES: The role of atrial fibrillation (AF) in older patients with heart failure (HF) is controversial because many variables seem to influence their outcome. We investigated the predictivity of AF in 3 age groups of outpatients with HF. METHODS: We analyzed 8,178 outpatients enrolled in the Italian Network on Congestive Heart Failure Registry with HF diagnosed according to the European Society of Cardiology criteria. A trained cardiologist established the diagnosis of AF and HF at the entry visit at each center. We stratified the population into 3 age groups, as follows: group A, < or =65 years; group B, 66-75 years, and group C, >75 years. RESULTS: Group A was composed of 4,261 patients, 683 with AF (16.0%); in group B there were 2,651 patients, 638 with AF (24.1%), and group C was composed of 1,266 patients, 412 with AF (32.5%). The 1-year mortality rate was higher in AF patients in all groups. In a multivariate model, AF remained an independent risk factor for death in groups A and B, but not in group C [group A: hazard ratio (HR) 1.42, 95% confidence interval (CI) 1.10-1.81; group B: HR 1.29, 95% CI 1.00-1.67; group C: HR 1.05, 95% CI 0.78-1.43]. CONCLUSION: The prevalence of AF increased with age and was associated with a higher mortality rate. However, AF independently predicted all-cause mortality only in patients aged < or =75 years.
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Baldasseroni et al. (2010) conducted a cohort in Chronic Heart Failure (n=8,178). Atrial fibrillation vs. No atrial fibrillation was evaluated on 1-year all-cause mortality (HR 1.42 (≤65 years), HR 1.29 (66-75 years), HR 1.05 (>75 years), 95% CI 1.10-1.81 (≤65 years), 1.00-1.67 (66-75 years), 0.78-1.43 (>75 years)). Atrial fibrillation independently predicted 1-year all-cause mortality in heart failure outpatients aged ≤65 years (HR 1.42; 95% CI 1.10-1.81) and 66-75 years, but not in those >75 years.
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