Pulse pressure ≥59 mmHg was independently associated with a 1.89-fold higher risk of first heart failure hospitalization in atrial fibrillation patients without prior HF.
Does higher pulse pressure increase the incidence of hospitalization for heart failure in atrial fibrillation patients without pre-existing heart failure?
Absolute Event Rate: 0% vs 0%
Abstract Background Hypertension is the commonest aetiological cause of atrial fibrillation (AF). Heart failure (HF) is a more frequent cardiovascular complication of AF than stroke. Blood vessels have the Windkessel effect and are involved in blood circulation, and an increased stiffness of the aorta and large arteries leads to an increase in pulse pressure (PP). We previously reported that PP was independently associated with cardiovascular events among patients with AF (The 85th Annual Scientific Meeting of the Japanese Circulation Society 2021). However, little is known about the impact of PP on HF in patients with AF. We investigated the relationship between PP and incidence of hospitalization for HF in patients without pre-existing HF, using data from the Fushimi AF Registry. Methods The Fushimi AF Registry, a community-based prospective survey, was designed to enroll all of the AF patients in the community. Follow-up data were available for 4,496 patients as of February 2022, and the median follow-up period was 2,096 days. Of them, we excluded 1,231 patients with pre-existing HF at baseline. Among 3,265 patients without pre-existing HF, data including PP at the baseline were available for 3,231 patients. We divided these patients into three groups according to PP tertile (T1:47 mmHg; n=1,001, T2: 47–58; n=1,111, T3: 59 or above; n=1,119), and compared the baseline clinical characteristics and incidence of hospitalization for HF. Results Age (70.7±11.4 vs. 71.7±11.0 vs. 74.6±9.6 years ; p0.01), systolic blood pressure (111.6±13.7 vs. 124.7±12.3 vs. 141.7±16.3 mmHg ; p0.01), distolic blood pressure (73.4±13.0 vs. 72.2±11.8 vs. 71.0±13.2 mmHg ; p0.01), prevalence of hypertension (50.9 vs. 61.9 vs. 73.5 %; p0.01) , diabetes (19.4 vs.20.7 vs. 28.4 %; p0.01), paroxysmal AF (50.7 vs. 57.5 vs. 58.5 %; p0.01), prior catheter ablation (9.8 vs. 6.6 vs. 5.9 %; p0.01), left atrial diameter (42.0±7.5 vs. 41.8±7.5 vs. 43.0±7.6 mm; p0.01) and N-terminal pro-brain natriuretic peptide level (543 vs. 494 vs. 425 pg/ml; p0.01) were different among groups. Prevalence of organic heart disease, the prescription of oral diuretics and left ventricular ejection fraction were comparable among groups. In Kaplan-Meier analysis, the incidence of HF was different among the groups during the median follow-up period of 2,155 days (T1 vs. T2 vs T3; 1.41% vs. 1.75% vs. 2.26% per person-year; p=0.002, by log-rank test) (Figure). PP (hazard ratio 95% confidential interval: T3/T1 1.89 1.15–3.09; p=0.01, T2/T1 1.42 0.86–2.33; p=0.17) was an independent predictor of the incidence of hospitalization for HF after adjustment for various potential confounders including the components of H2ARDD score (organic heart disease, anemia, chronic kidney disease, diabetes and diuretic use) (Table). Conclusion PP was independently associated with incidence of first hospitalization for HF among Japanese AF patients without pre-existing HF.
Tezuka et al. (Sat,) reported a other. Pulse pressure ≥59 mmHg was independently associated with a 1.89-fold higher risk of first heart failure hospitalization in atrial fibrillation patients without prior HF.