A 24-hour atrial fibrillation episode was associated with an increased risk of heart failure events compared with no 24-hour AF (HR 3.37; 95% CI 1.95-5.82; p<0.001).
Cohort (n=613)
Yes
Does atrial fibrillation burden associate with changes in HeartLogic multi-sensor measurements and subsequent heart failure events in patients with cardiac devices?
HeartLogic multi-sensor measurements predictive of heart failure decompensation worsen prior to atrial fibrillation onset, and a 24-hour AF episode is associated with a significantly increased risk of subsequent HF events.
Effect estimate: HR 3.37 (95% CI 1.95-5.82)
p-value: p=<0.001
Abstract Background The burden of atrial fibrillation (AF) is high among patients with heart failure (HF), and it can be challenging to determine whether an episode of AF precipitates decompensation or vice versa. As such, it can be complex to identify the appropriate focus of treatment. The HeartLogic multi-sensor algorithm was found to be predictive of impending HF decompensation. Purpose In this study, we aimed to evaluate the temporal association between changes in physiologic HF sensors and AF progression in patients implanted with a cardiac device compatible with the HeartLogic multi-sensor remote monitoring algorithm. Methods This was a retrospective analysis of the Danish nationwide cohort of patients eligible for inclusion in the DANLOGIC-HF trial. Patients were followed between February 2017 and November 2024 and grouped according to their longest daily AF burden - 1) at least 24 hours of AF (HIGH AF); 2) between 6 minutes and 24 hours (MID AF); and 3) 6 minutes (NO AF). HeartLogic sensor data were aligned to the first qualifying AF event (for patients with HIGH or MID AF) or a randomly selected index day (for patients with NO AF). HF events were defined as hospitalization for decompensated HF or intravenous HF treatment. Associations were assessed by time-dependent Cox proportional hazard models, and device sensor changes were compared using 1-way analysis of variance followed by Tukey’s post hoc analysis. Results Among 613 patients with daily AF data available, the mean age was 62±13 years, and 446 (73%) were male. A total of 436 (71%) patients had a CRT-D, and 461 (75%) had the diagnosis of HF at baseline. HIGH AF episodes were prevalent in 106 patients (17%), 109 (17%) had MID AF, and 398 (65%) had NO AF. For patients with HIGH AF, HeartLogic index increased prior to AF onset both when compared to patients without AF (delta 6.87 ± 11.15) and MID AF (p0.001 for both). Also, first heart sound measurements, known to be associated with ventricular contraction, decreased for HIGH AF patients (delta -0.36 ± 0.61) compared to patients without AF and MID AF (p0.001 for both), while third heart sound measurements, associated with ventricular filling pressure, increased (delta 0.02 ± 0.18) compared to patients with NO AF (p=0.057). Thoracic impedance, associated with cardiovascular congestion, increased for both MID AF (delta 1.17 ± 4.68, p=0.952) and HIGH AF patients (delta 0.90 ± 3.49, p=0.582), although changes were not statistically significant. There was an increased risk for HF events following a 24-hour AF episode compared with no 24-hour AF (hazard ratio 3.37, 95% CI 1.95;5.82, p0.001). Conclusion Measurements predictive of impending HF decompensation worsened before AF onset which corresponded to the finding of an increased risk of HF events following an AF episode.Figure 1
Davodian et al. (Sat,) conducted a cohort in Heart failure and atrial fibrillation (n=613). 24-hour atrial fibrillation episode (HIGH AF) vs. No 24-hour AF was evaluated on Heart failure events (hospitalization for decompensated HF or intravenous HF treatment) (HR 3.37, 95% CI 1.95-5.82, p=<0.001). A 24-hour atrial fibrillation episode was associated with an increased risk of heart failure events compared with no 24-hour AF (HR 3.37; 95% CI 1.95-5.82; p<0.001).