Key result
Active smoking links to ~73% greater risk of incident AF with HF than AF alone.
Why the study?
Heart failure frequently complicates atrial fibrillation and increases mortality risk, but limited data exist on the modifiable risk factors associated with heart failure development in atrial fibrillation patients.
Do modifiable risk factors predict incident atrial fibrillation with heart failure compared to atrial fibrillation alone in a population without prior AF or HF?
Cohort (n=60,320)
Do modifiable risk factors predict incident atrial fibrillation with heart failure compared to atrial fibrillation alone in a population without prior AF or HF?
Effect estimate: HR 1.73 (95% CI 1.54-1.95)
p-value: p=<0.0001
Obesity, hypertension, active smoking, and diabetes are strongly associated with the development of incident atrial fibrillation complicated by heart failure, accounting for over half of the population attributable risk.
Smoking and higher SBP may flag higher AF-to-HF risk; leaves open whether modification alters progression in trials.
OBJECTIVE: Heart failure (HF) frequently complicates atrial fibrillation (AF) and significantly increases mortality risk. Limited data exist on the modifiable risk factors associated with development of HF in AF patients. METHODS: We examined two large, prospective, population-based cohorts without prior AF or HF at baseline: Malmö Preventive Project (MPP, n=32 625) and Malmö Diet and Cancer Study (MDCS, n=27 695). Using Lunn-McNeil competing risks, multivariable Cox models were constructed to determine hazard ratios (HR) and 95% confidence intervals (CI) of risk factors for incident HF with AF, and AF alone. RESULTS: ), systolic blood pressure (HR 1.20, 95% CI 1.24 to 1.26 vs HR 1.08, 95% CI 1.06 to 1.10 per 10 mm Hg) and current cigarette smoking (HR 1.73, 95% CI 1.54 to 1.95 vs HR 1.23, 95% CI 1.15 to 1.32) had stronger associations with incident AF with HF compared with AF alone (all p for difference <0.0001). Similar results were observed in MDCS (all p for difference <0.009). These three risk factors and diabetes accounted for 51.8% and 54.1% of the population attributable risk (PAR) for AF with HF in MPP and MDCS, respectively, compared with 20.1% and 27.0% for AF alone. CONCLUSIONS: Obesity, hypertension and active smoking preferentially associated with AF with HF, compared with AF alone, and accounted for >50% of the PAR. Randomised trials are needed to assess whether risk factor modification can reduce the incidence of AF with HF and reduce mortality.
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Wong et al. (2020) conducted a cohort in Atrial fibrillation and heart failure (n=60,320). Modifiable risk factors (obesity, hypertension, smoking, diabetes) vs. Atrial fibrillation alone was evaluated on Incident atrial fibrillation with heart failure compared with atrial fibrillation alone (HR 1.73, 95% CI 1.54-1.95, p=<0.0001). Active smoking (HR 1.73; 95% CI 1.54-1.95) and higher systolic blood pressure were more strongly associated with incident AF with HF than AF alone (P<0.0001 for difference).
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