Key result
Heart failure preceding atrial fibrillation was associated with a higher risk of all-cause death compared to incident heart failure (21.6 vs. 19.3%/year; HR 1.10; 95% CI 1.08-1.11).
Why the study?
AF and HF often co-exist and worsen each other, but the temporal relationships between these two disorders have not yet been fully explored.
Does the temporal sequence of heart failure and atrial fibrillation development affect clinical outcomes in patients with both conditions?
Population
1,349,638 patients diagnosed with both AF and HF in France
Comparison
Patients developing HF before AF vs patients developing HF after AF
Design
Nationwide administrative database cohort study with propensity score matching
Follow-up
Mean follow-up 1.6 ± 1.9 year
Authors
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Prevalent HF before AF signals higher mortality and rehospitalization risk; leaves open whether onset sequence guides risk stratification or interventions.
Cohort (n=1,349,638)
Yes
Does the temporal sequence of heart failure and atrial fibrillation development affect clinical outcomes in patients with both conditions?
Hazard Ratio: 1.1 (95% CI 1.08–1.11)
Absolute Event Rate: 21.6% vs 19.3%
Patients who develop heart failure before atrial fibrillation have a higher risk of mortality and heart failure hospitalization compared to those who develop atrial fibrillation first.
Cottin et al. (2021) conducted a cohort in Atrial fibrillation and heart failure (n=1,349,638). Heart failure preceding atrial fibrillation (prevalent HF) vs. Heart failure developing after atrial fibrillation (incident HF) was evaluated on All-cause death (HR 1.10, 95% CI 1.08-1.11). Heart failure preceding atrial fibrillation was associated with a higher risk of all-cause death compared to incident heart failure (21.6 vs. 19.3%/year; HR 1.10; 95% CI 1.08-1.11).