What is the clinical evidence from this study?

Study design: Cohort. Population: Heart failure with mildly reduced and preserved ejection fraction (n=429464). Intervention: Atrial fibrillation vs. No history of atrial fibrillation. Primary outcome: 12-month all-cause mortality (p=<0.0001).

November 7, 2022Open Access

Intersection of Atrial Fibrillation and Heart Failure with Mildly Reduced and Preserved Ejection Fraction in 400 000 Participants in the Get With The Guidelines-Heart Failure Registry

Q: What are the key findings of this study?

Comorbid atrial fibrillation in patients hospitalized for heart failure with mildly reduced or preserved ejection fraction was associated with a higher 12-month risk of all-cause mortality (35% vs 29%).

Key Result

Comorbid atrial fibrillation in patients hospitalized for heart failure with mildly reduced or preserved ejection fraction was associated with a higher 12-month risk of all-cause mortality (35% vs 29%).

Study Design

Type

Cohort (n=429,464)

Multicenter

Yes

Structured PICO

What are the AF-specific care patterns and post-discharge outcomes among patients hospitalized for HFmrEF or HFpEF, based on AF history?

Population

>400,000 patients hospitalized for heart failure with mildly reduced ejection fraction (HFmrEF) or preserved ejection fraction (HFpEF) in the Get With The Guidelines-Heart Failure Registry

Comparator

Patients without a history of atrial fibrillation

Outcome

AF-specific medical therapies (anti-arrhythmic drugs, anticoagulants) and post-discharge outcomes (death and rehospitalization)hard clinical

In patients hospitalized with HFmrEF or HFpEF, comorbid AF is increasingly prevalent and associated with worse outcomes, yet the use of AF-specific therapies like anticoagulation and rhythm control remains modest.

Main Result

Absolute Event Rate: 35% vs 29%

p-value: p=<0.0001

Limitations

Ascertainment of AF was based upon case report forms without adjudicated electrocardiograms
AF type (paroxysmal, persistent, permanent) was not captured
Participation in GWTG-HF is voluntary, which may affect generalizability
Analyses of post-discharge outcomes and prescriptions were limited to Medicare Fee-for-Service beneficiaries
Dose of anti-arrhythmic drugs was not captured
Readmission data relied upon ICD coding and causes of hospitalizations were not independently adjudicated

Abstract

AIMS: Although atrial fibrillation (AF) frequently coexists with heart failure with preserved ejection fraction (HFpEF), few data are available evaluating AF-specific care patterns and post-discharge outcomes in patients hospitalized for HFpEF. We evaluated AF-specific medical therapies and post-discharge outcomes among patients hospitalized for heart failure with mildly reduced ejection fraction (HFmrEF) or HFpEF by AF history. METHODS AND RESULTS: = 0.009). Anti-arrhythmic drug use after heart failure hospitalization was low (18%) and increased modestly over time. Amiodarone accounted for 71% of total anti-arrhythmic drug prescriptions. Overall use of anticoagulants after heart failure hospitalization has significantly increased from 52% in 2014 to 61% in 2019, but remained modest. CONCLUSION: Prevalence of AF is rising among patients hospitalized with HFpEF. Those with comorbid AF face elevated post-discharge risks of death and rehospitalization. Current use of pharmacological rhythm control is low.

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Cite This Study

Patel et al. (Mon,) conducted a cohort in Heart failure with mildly reduced and preserved ejection fraction (n=429,464). Atrial fibrillation vs. No history of atrial fibrillation was evaluated on 12-month all-cause mortality (p=<0.0001). Comorbid atrial fibrillation in patients hospitalized for heart failure with mildly reduced or preserved ejection fraction was associated with a higher 12-month risk of all-cause mortality (35% vs 29%).

synapsesocial.com/papers/6a08814a9a6c4ba6e610abb8 https://doi.org/https://doi.org/10.1002/ejhf.2729

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