Epidemiology and management of coexisting heart failure and atrial fibrillation in an outpatient setting

INTRODUCTION: Atrial fibrillation (AF) is the most common arrhythmia complicating heart failure (HF). The coexistence of these diseases may be partially explained by the presence of common risk factors. Although the effect of AF on the prognosis in HF is still debatable, it is associated with specific complications and affects therapy. OBJECTIVES: The aim of this analysis was to evaluate epidemiology and management of coexisting HF and AF among Polish outpatients. PATIENTS AND METHODS: The present study was performed within the framework of the Polish National Cardiovascular Disease Prevention and Treatment Program, POLKARD 2003-2005, and included patients with HF treated in a representative number of 400 outpatient clinics. Data was collected using questionnaires and included demographic characteristics as well as information about coexisting diseases and treatment, provided by patients and physicians on the basis of the available medical records. RESULTS: The study involved 3682 patients with HF (mean age 67.1 ±11.7 years; 58% of patients were men). AF was present in 38% of the patients. The prevalence of arrhythmia increased with the New York Heart Association class. We observed significant differences between the subgroups of patients with AF and those with sinus rhythm in terms of demographic parameters, risk factors, concomitant diseases, and therapy. Although the use of angiotensin-converting enzyme inhibitors and β-blockers was significantly lower in the subgroup with AF, a multivariable analysis showed that it was associated with specific demographic characteristics and comorbidities rather than with arrythmia itself. Specialty patient care was associated with increased use of therapy aimed to improve the prognosis of HF patients. CONCLUSIONS: Patients with AF constitute a particular subgroup within the population of patients with HF. A specific distribution of risk factors with a significant effect of noncardiac diseases may confound HF therapy in this patient group. Specialty care may be able to optimize treatment in patients with coexisting HF and AF.