Incidence and impact of atrial fibrillation in heart failure patients: real‐world data in a large community

Abstract

AimsThe objective of the present study is to assess the bidirectional association between heart failure (HF) and atrial fibrillation (AF) using real-world data. Methods and resultsFrom an electronic health recording with a population of 3 799 885 adult subjects, those with prevalent or incident HF were selected and followed throughout a study period of 5 years. Prevalence and incidence of AF, and their impact in the risk for acute HF hospitalization, worsening renal function, ischaemic and haemorrhagic stroke, and all-cause mortality were identified. We analysed all incident and prevalent patients with HF and AF, 128 086 patients (S1), and subsequently analysed a subset of patients with incident HF and AF, 57 354 patients (S2). We analysed all incident and prevalent patients with HF and AF, 128 086 patients (S1), and subsequently a subset of patients with incident HF and AF, 57 354 patients (S2). The prevalence of AF was 59 906 (46.7%) of the HF patients, while incidence in the S2 was 231/1000 patients/year. In both cohorts, S1 and S2, AF significantly increases the risk of acute heart failure hospitalization [incidence 79.1/1000 and 97.5/1000 patients/year; HR 1.53 (1.48-1.59 95% CI) and HR 1.32 (1.24-1.41 95% CI), respectively], risk of decreased renal function (eGFR reduced by >20%) [66.2/1000 and 94.0/1000 patients/year; HR 1.13 (1.09-1.18 95% CI) and HR 1.22 (1.14-1.31 95% CI), respectively] and all-cause mortality [203/1000 and 294/1000 patients/year; HR 1.62 (1.58-1.65 95% CI) and HR 1.65 (1.59-1.70 95% CI), respectively]. The number of episodes of hospitalization for acute heart failure was also significantly higher in the AF patients (27 623 vs. 10 036, P < 0.001). However, the risk for ischaemic stroke was reduced in the AF subjects [HR 0.66 (0.63-0.74 95% CI)], probably due to the anticoagulant treatment. Conclusions AF is associated with an increment in the risk of episodes of acute heart failure as well as decline of renal function and increment of all-cause mortality.

Correlation Between Warfarin Levels in the Blood and the Value of Normal INR in Fibrillation Atrium Inpatients

“…It might also aggravate the symptoms of heart failure. 23 The incidence of atrial fibrillation in heart failure patients was 46.7%, significantly increasing the risk of acute heart failure hospitalisation 24 . Meanwhile, the most common non-cardiovascular disease that accompanies atrial fibrillation is dyspepsia (12.5%).…”

The Optimal Management of Patients with Atrial Fibrillation and Acute Heart Failure in the Emergency Department

“…Accumulative data from large-scale studies and registries indicate that AF is present in approximately 35% of the patients who are admitted to the emergency department (ED) with signs and/or symptoms suggestive of HF deterioration (Table 1) [4][5][6][7][8][9][10][11][12][13], while 20% experience a new episode of AF during hospitalization [14][15][16]. In the context of AHF, AF represents an independent predictor of morbidity, all-cause mortality and adverse in-hospital outcomes.…”

Nomograms for Predicting the Risk of Acute Heart Failure in ICU Patients with Atrial Fibrillation: A Retrospective Cohort Study

“…The mechanisms include activation of the renin angiotensin aldosterone system (RAAS), mechanical traction on the left atrium, and atrial electrophysiological remodelling [10,12,[13][14][15]. AF also plays a role in the occurrence and progression of AHF [16].…”

“…The mechanisms include activation of the renin angiotensin aldosterone system (RAAS), mechanical traction on the left atrium, and atrial electrophysiological remodelling [10, 12, 13-15]. AF also plays a role in the occurrence and progression of AHF [16]. Thus far, research has mainly focused on the incidence of AF in patients with AHF; few studies have examined the incidence of AHF in patients with AF.…”