Incident atrial fibrillation and mortality in older adults with heart failure

Abstract

We studied 944 hospitalized heart failure patients 65 years and older to examine the impact of incident atrial fibrillation on mortality. Patients were categorized into four groups based on past medical history and admission electrocardiogram: (1) no (neither past nor current), (2) incident (newly diagnosed), (3) past and (4) chronic (past and current) atrial fibrillation. The primary outcome was 4-year all-cause mortality. Bivariate and multivariable Cox proportion hazards analyses were used to determine risk of all-cause mortality. In the multivariable model, we adjusted for various demographic and clinical covariates. Compared with patients who never had atrial fibrillation, those with incident atrial fibrillation had a 57% higher risk of death (unadjusted hazard ratio, 1.57; 95% confidence interval, 1.22-2.03). After adjustment for other covariates the association remained unchanged (adjusted hazard ratio, 1.41; 95% confidence interval, 1.08-1.83). Past or chronic atrial fibrillation was not associated with increased risk of death.

Presence of Atrial Fibrillation Is Independently Associated With Adverse Outcomes in Patients Hospitalized With Heart Failure

“…New-onset AF had been previously linked to long-term mortality in the outpatient setting. Ahmed et al 26 showed in a retrospective analysis of 944 hospitalized elderly patients with HF that new onset AF but not preexisting AF carried a significantly higher risk for 4 year all-cause mortality. Similar association between new-onset AF and mortality and absence of association between preexisting AF and mortality was reported in an analysis of COMET trial.…”

Prevalence, pathogenesis, and impact of atrial fibrillation

“…18 The development of AF has adverse prognostic implications in patients with HF. 19,20 In a retrospective analysis of more than 6500 patients with asymp tomatic or symptomatic HF, the presence of AF increased the rates of all-cause mortality, progressive pump failure-related death, and a composite endpoint of death or hospitalization for HF compared with patients who were in sinus rhythm. 19 The time course of development of AF has also been shown to have an adverse impact on prognosis in patients with HF.…”

Management of Atrial Fibrillation in Patients With Structural Heart Disease

“…[17][18][19][20] Newonset AF also appears to have a particularly negative impact on the prognosis of patients with HF. Ahmed and Perry 21 found that among 944 elderly patients hospitalized with HF, new-onset AF was associated with a higher risk of death compared with patients who never developed AF or those with permanent AF. More than 80% of patients hospitalized with HF and new AF died within 4 years of discharge as opposed to 61% to 66% mortality for those without AF or with chronic AF.…”