A meta‐analysis of the prognostic significance of atrial fibrillation in chronic heart failure

Abstract

AimsAtrial fibrillation (AF) is one of the commonest sustained arrhythmias in chronic heart failure (CHF), although the prognostic implications of the presence of AF in CHF remain controversial. We have therefore performed this meta-analysis to study the effects of the presence of AF on mortality in CHF patients. Methods and resultsA systematic MEDLINE search for all randomized trials and observational studies in which the influence of AF on CHF mortality was investigated and meta-analysis of the mortality data was performed. A total of 16 studies were identified of which 7 were randomized trials and 9 were observational studies including 30 248 and 23 721 patients, respectively. An adjusted meta-analysis of the data revealed that the presence of AF is associated with an adverse effect on total mortality with an odds ratio (OR) of 1.40 [95% confidence interval (CI) 1.32-1.48, P , 0.0001] in randomized trials and an OR of 1.14 (95% CI 1.03-1.26, P , 0.05) in observational studies. This increase in mortality associated with the presence of AF was observed in subgroups of CHF patients with both preserved and impaired left ventricular (LV) systolic function. ConclusionIn conclusion, meta-analysis of 16 studies involving 53 969 patients suggests that the presence of AF is associated with an adverse prognosis in CHF irrespective of LV systolic function.--

Comparison of the Usefulness of Cardiac Resynchronization Therapy in Three Age-Groups (<65, 65-74 and ≥75 Years) (from the InSync/InSync ICD Italian Registry)

“…Results from the Candesartan in Heart Failure-Assessment of Reduction in Mortality and Morbidity (CHARM) program, 24 then confirmed by a meta-analysis of 7 randomized trials and 9 observational studies, 25 proved that the presence of AF determined an increased risk for morbidity and mortality in patients with symptomatic heart failure regardless of baseline LVEF. Moreover, as shown by the Euro Heart Survey on AF, when CHF and AF coexist, the underprescription of guidelines-recommended medical therapy can be further potentiated.…”

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

“…Niewydolność serca i AF mogą wywoływać i nasilać się wzajemnie za pośrednictwem takich mechanizmów, jak strukturalna przebudowa serca, aktywacja mechanizmów neurohormonalnych oraz zależne od częstości rytmu komór zaburzenie czynności lewej komory. U pacjentów z AF i współ-istniejącą niewydolnością serca, zarówno z zachowaną frakcją wyrzutową (frakcja wyrzutowa lewej komory (LVEF) ≥ 50%), jak i ze zmniejszoną frakcją wyrzutową (LVEF < 40%) [219,220], obserwuje się gorsze rokowanie, w tym większą umieralność [16,221]. W najnowszych wytycznych ESC dotyczących niewydolności serca [222] wprowadzono nową kategorię niewydolności serca z pośrednią frakcją wyrzutową (HFmrEF; LVEF 40-49%), choć dane na temat pacjentów z AF w tej grupie są ograniczone.…”

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

“…218 Heart failure and AF can cause and exacerbate each other through mechanisms such as structural cardiac remodelling, 219,220 suffer from a worse prognosis, including increased mortality. 16, 221 The recent ESC Guidelines on heart failure 222 have also introduced a new category of heart failure with mid-range ejection fraction (HFmrEF; LVEF 40 -49%), although data on AF patients in this group are limited. Prevention of adverse outcomes and maintenance of a good quality of life are the aims of management in all patients with AF and concomitant heart failure, regardless of LVEF.…”