The online version of this article (https://doi.org/10.1007/s00392-019-01463-5) contains supplementary material, which is available to authorized users.
Simon G. Anderson and Ahmad Shoaib contributed equally.
Simon G. Anderson and Ahmad Shoaib are co-first authors.
Atrial fibrillation (AF) is the most common sustained arrhythmia in patients with acute heart failure (AHF). The presence of AF is associated with adverse prognosis in patients with chronic heart failure (CHF) but little is known about its impact in AHF.
Data were collected between April 2007 and March 2013 across 185 (> 95%) hospitals in England and Wales from patients with a primary death or a discharge diagnosis of AHF. We investigated the association between the presence of AF and all-cause mortality during the index hospital admission, at 30 days and 1 year post-discharge.
Of 96,593 patients admitted with AHF, 44,642 (46%) were in sinus rhythm (SR) and 51,951 (54%) in AF. Patients with AF were older (mean age 79.8 (79.7–80) versus 74.7 (74.5–74.7) years; p < 0.001), than those in SR. In a multivariable analysis, AF was independently associated with mortality at all time points, in hospital (HR 1.15, 95% CI 1.09–1.21, p < 0.0001), 30 days (HR 1.13, 95% CI 1.08–1.19, p < 0.0001), and 1 year (HR 1.09, 95% CI 1.05–1.12, p < 0.0001). In subgroup analyses, AF was independently associated with worse 30-day outcome irrespective of sex, ventricular phenotype and in all age groups except in those aged between 55 and 74 years.
AF is independently associated with adverse prognosis in AHF during admission and up to 1 year post-discharge. As the clinical burden of concomitant AF and AHF increases, further refinement in the detection, treatment and prevention of AF-related complications may have a role in improving patient outcomes.
McMurray JJV, Packer M, Desai AS, Gong J, Lefkowitz MP, Rizkala AR et al (2014) Angiotensin–neprilysin inhibition versus enalapril in heart failure. N Engl J Med 371(11):993–1004 CrossRef
Zannad F, McMurray JJV, Krum H, van Veldhuisen DJ, Swedberg K, Shi H et al (2011) Eplerenone in patients with systolic heart failure and mild symptoms. N Engl J Med 364(1):11–21 CrossRef
Gijsberts CM, Benson L, Dahlström U, Sim D, Yeo DPS, Ong HY et al (2016) Ethnic differences in the association of QRS duration with ejection fraction and outcome in heart failure. Heart (British Cardiac Society) 102:1464–1471
Emdin CA, Conrad N, Kiran A, Salimi-Khorshidi G, Woodward M, Anderson SG et al (2017) Variation in hospital performance for heart failure management in the National Heart Failure Audit for England and Wales. Heart 103(1):55–62 CrossRef
Khan MA, Satchithananda DK, Mamas MA (2016) The importance of interactions between atrial fibrillation and heart failure. Clin Med (Lond, Engl) 16(3):272–276 CrossRef
Mamas MA, Caldwell JC, Chacko S, Garratt CJ, Fath-Ordoubadi F, Neyses L (2009) A meta-analysis of the prognostic significance of atrial fibrillation in chronic heart failure. Eur J Heart Failure 11(7):676–683 CrossRef
Mountantonakis SE, Grau-Sepulveda MV, Bhatt DL, Hernandez AF, Peterson ED, Fonarow GC (2012) Presence of atrial fibrillation is independently associated with adverse outcomes in patients hospitalized with heart failure: an analysis of get with the guidelines-heart failure. Circ Heart Fail 5(2):191–201 CrossRef
Llorens P, Javaloyes P, Martin-Sanchez FJ, Jacob J, Herrero-Puente P, Gil V et al (2018) Time trends in characteristics, clinical course, and outcomes of 13,791 patients with acute heart failure. Clin Res Cardiol 107(10):897–913 CrossRef
Filippatos G, Farmakis D, Metra M, Cotter G, Davison BA, Felker GM et al (2017) Serelaxin in acute heart failure patients with and without atrial fibrillation: a secondary analysis of the RELAX-AHF trial. Clin Res Cardiol 106(6):444–456 CrossRef
Rivero-Ayerza M, Scholte Op Reimer W, Lenzen M, Theuns DA, Jordaens L, Komajda M et al (2008) New-onset atrial fibrillation is an independent predictor of in-hospital mortality in hospitalized heart failure patients: results of the EuroHeart Failure Survey. Eur Heart J 29(13):1618–1624 CrossRef
Pedersen OD, Sondergaard P, Nielsen T, Nielsen SJ, Nielsen ES, Falstie-Jensen N et al (2006) Atrial fibrillation, ischaemic heart disease, and the risk of death in patients with heart failure. Eur Heart J 27(23):2866–2870 CrossRef
Miro O, Gil VI, Martin-Sanchez FJ, Jacob J, Herrero P, Alquezar A et al (2018) Short-term outcomes of heart failure patients with reduced and preserved ejection fraction after acute decompensation according to the final destination after emergency department care. Clin Res Cardiol 107(8):698–710 CrossRef
Meyer S, Teerlink JR, Metra M, Ponikowski P, Cotter G, Davison BA et al (2017) Sex differences in early dyspnea relief between men and women hospitalized for acute heart failure: insights from the RELAX-AHF study. Clin Res Cardiol 106(4):280–292 CrossRef
Cleland JG, McDonagh T, Rigby AS, Yassin A, Whittaker T, Dargie HJ (2011) The national heart failure audit for England and Wales 2008–2009. Heart 97(11):876–886 CrossRef
Cleland J, Dargie H, Hardman S, Mcdonagh T, Mitchell P (2013) National Heart Failure Audit April 2012–March 2013. http://www.ucl.ac.uk/nicor/audits/heartfailure/additionalfiles/pdfs/annualreports/NHFA13medium.pdf. Accessed 21 Nov 2013
Austin PC (2009) Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples. Stat Med 28(25):3083–3107 CrossRef
Vandenbroucke JP, von Elm E, Altman DG, Gotzsche PC, Mulrow CD, Pocock SJ et al (2007) Strengthening the reporting of observational studies in epidemiology (STROBE): explanation and elaboration. Epidemiology 18(6):805–835 CrossRef
Abualnaja S, Podder M, Hernandez AF, McMurray JJ, Starling RC, O’Connor CM et al (2015) Acute heart failure and atrial fibrillation: insights from the acute study of clinical effectiveness of nesiritide in decompensated heart failure (ASCEND-HF) trial. J Am Heart Assoc 4(8):e002092 CrossRef
McDonagh T, Cleland J, Dargie HJ, Whittaker T, Standing M, Mitchell M et al (2012) National Heart Failure Audit April 2010–March 2011
Anter E, Jessup M, Callans DJ (2009) Atrial fibrillation and heart failure: treatment considerations for a dual epidemic. Circulation 119(18):2516–2525 CrossRef
Caldwell J, Mamas M, Garratt C, Neyses L (2008) How common is asymptomatic paroxysmal atrial fibrillation in chronic heart failure? Scand Cardiovasc J SCJ 42(6):366 (author reply 7) CrossRef
Kareti KR, Chiong JR, Hsu SS, Miller AB (2005) Congestive heart failure and atrial fibrillation: rhythm versus rate control. J Card Fail 11(3):164–172 CrossRef
Sramko M, Wichterle D, Melenovsky V, Franekova J, Clemens M, Fukunaga M et al (2019) Independent effect of atrial fibrillation on natriuretic peptide release. Clin Res Cardiol 108(2):142–149 CrossRef
Llach A, Molina CE, Prat-Vidal C, Fernandes J, Casado V, Ciruela F et al (2011) Abnormal calcium handling in atrial fibrillation is linked to up-regulation of adenosine A2A receptors. Eur Heart J 32(6):721–729 CrossRef
Li D, Fareh S, Leung TK, Nattel S (1999) Promotion of atrial fibrillation by heart failure in dogs. Atrial Remodel Differ Sort 100(1):87–95
Dries DL, Exner DV, Gersh BJ, Domanski MJ, Waclawiw MA, Stevenson LW (1998) Atrial fibrillation is associated with an increased risk for mortality and heart failure progression in patients with asymptomatic and symptomatic left ventricular systolic dysfunction: a retrospective analysis of the SOLVD trials. Studies of left ventricular dysfunction. J Am Coll Cardiol 32(3):695–703 CrossRef
Swedberg K, Olsson LG, Charlesworth A, Cleland J, Hanrath P, Komajda M et al (2005) Prognostic relevance of atrial fibrillation in patients with chronic heart failure on long-term treatment with beta-blockers: results from COMET. Eur Heart J 26(13):1303–1308 CrossRef
Middlekauff HR, Stevenson WG, Stevenson LW (1991) Prognostic significance of atrial fibrillation in advanced heart failure. A study of 390 patients. Circulation 84(1):40–48 CrossRef
Linssen GC, Rienstra M, Jaarsma T, Voors AA, van Gelder IC, Hillege HL et al (2011) Clinical and prognostic effects of atrial fibrillation in heart failure patients with reduced and preserved left ventricular ejection fraction. Eur J Heart Fail 13(10):1111–1120 CrossRef
Kotecha D, Chudasama R, Lane DA, Kirchhof P, Lip GY (2016) Atrial fibrillation and heart failure due to reduced versus preserved ejection fraction: a systematic review and meta-analysis of death and adverse outcomes. Int J Cardiol 203:660–666 CrossRef
Kober L, Swedberg K, McMurray JJ, Pfeffer MA, Velazquez EJ, Diaz R et al (2006) Previously known and newly diagnosed atrial fibrillation: a major risk indicator after a myocardial infarction complicated by heart failure or left ventricular dysfunction. Eur J Heart Fail 8(6):591–598 CrossRef
Schneider MP, Hua TA, Böhm M, Wachtell K, Kjeldsen SE, Schmieder RE (2010) Prevention of atrial fibrillation by renin–angiotensin system inhibition. A meta-analysis. J Am Coll Cardiol 55(21):2299–2307 CrossRef
Jibrini MB, Molnar J, Arora RR (2008) Prevention of atrial fibrillation by way of abrogation of the renin–angiotensin system: a systematic review and meta-analysis. Am J Ther 15(1):36–43 CrossRef
Goette A, Schon N, Kirchhof P, Breithardt G, Fetsch T, Hausler KG et al (2012) Angiotensin II-antagonist in paroxysmal atrial fibrillation (ANTIPAF) trial. Circ Arrhythm Electrophysio 5(1):43–51 CrossRef
Yusuf S, Healey JS, Pogue J, Chrolavicius S, Flather M, Hart RG et al (2011) Irbesartan in patients with atrial fibrillation. N Engl J Med 364(10):928–938 CrossRef
Kotecha D, Flather MD, Altman DG, Holmes J, Rosano G, Wikstrand J et al (2017) Heart rate, heart rhythm, and prognostic benefits of beta-blockers in heart failure: individual patient-data meta-analysis. J Am Coll Cardiol 69(24):2885–2896. https://doi.org/10.1016/j.jacc.2017.04.001 CrossRefPubMed
Mordi IR, Santema BT, Kloosterman M, Choy AM, Rienstra M, van Gelder I et al (2019) Prognostic significance of changes in heart rate following uptitration of beta-blockers in patients with sub-optimally treated heart failure with reduced ejection fraction in sinus rhythm versus atrial fibrillation. Clin Res Cardiol. https://doi.org/10.1007/s00392-018-1409-x CrossRefPubMedPubMedCentral
Swedberg K, Zannad F, McMurray JJ, Krum H, van Veldhuisen DJ, Shi H et al (2012) Eplerenone and atrial fibrillation in mild systolic heart failure: results from the EMPHASIS-HF (Eplerenone in Mild Patients Hospitalization And SurvIval Study in Heart Failure) study. J Am Coll Cardiol 59(18):1598–1603 CrossRef
Farmakis D, Simitsis P, Bistola V, Triposkiadis F, Ikonomidis I, Katsanos S et al (2017) Acute heart failure with mid-range left ventricular ejection fraction: clinical profile, in-hospital management, and short-term outcome. Clin Res Cardiol 106(5):359–368 CrossRef
Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ et al (2016) 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Revista espanola de cardiologia (Engl ed) 69(12):1167
- Does rhythm matter in acute heart failure? An insight from the British Society for Heart Failure National Audit
Simon G. Anderson
Phyo Kyaw Myint
John G. Cleland
Suzanna M. Hardman
Theresa A. McDonagh
Clifford J. Garratt
Mamas A. Mamas
- Springer Berlin Heidelberg
Neu im Fachgebiet Kardiologie
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