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08.04.2019 | Original Paper | Ausgabe 11/2019 Open Access

Clinical Research in Cardiology 11/2019

Does rhythm matter in acute heart failure? An insight from the British Society for Heart Failure National Audit

Clinical Research in Cardiology > Ausgabe 11/2019
Simon G. Anderson, Ahmad Shoaib, Phyo Kyaw Myint, John G. Cleland, Suzanna M. Hardman, Theresa A. McDonagh, Henry Dargie, Bernard Keavney, Clifford J. Garratt, Mamas A. Mamas
Wichtige Hinweise

Electronic supplementary material

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.

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