Τhe association of heart failure across left ventricular ejection fraction with mortality in atrial fibrillation

Abstract

Aims The aim of this study is to investigate the prognostic implications of the presence of heart failure (HF) across the range of left ventricular ejection fraction (LVEF) in patients with comorbid atrial fibrillation (AF). Methods and resultsWe conducted a retrospective cohort study of 1063 patients (median age 76 years), discharged from the cardiology ward with a primary or secondary diagnosis of AF between 2015 and 2018. We used Cox proportional-hazards and spline models to examine the association of the presence of HF, across the range of LVEF, with the primary outcome of all-cause mortality. HF was documented in 52.9% of patients at baseline. During a median follow-up of 31 months (interquartile range 10 to 52 months), 37.3% of patients died. The presence of HF was associated with a significantly higher risk of mortality [adjusted hazard ratio (aHR) 2.17; 95% confidence interval (CI), 1.70 to 2.77; P < 0.001], which was evident across HF with reduced (aHR 3.03; 95% CI 2.41 to 4.52), mid-range (aHR 2.08; 95% CI 1.47 to 2.94), and preserved LVEF (aHR 1.94; 95% CI 1.47 to 2.55). Among patients with HF, the spline curve depicted a non-linear association between LVEF and the risk of death, in which there was a steep and progressive increase in mortality for every 5% reduction in LVEF below 25% (aHR 1.97, 95% CI 1.04 to 3.73, P = 0.04). Conclusions In patients with AF who were discharged from the hospital, the presence of HF at baseline was independently associated with a twofold risk of death, which was significant across LVEF-classified HF subtypes. Among patients with AF and HF, the risk of death rose significantly as LVEF was reduced below 25%.

Prescription Rates and Prognostic Implications of Optimally Targeted Guideline-Directed Medical Treatment in Heart Failure and Atrial Fibrillation: Insights From The MISOAC-AF Trial

“…This could be attributed to the significantly higher survival rates of patients with HFmrEF compared with patients with HFrEF in the MISOAC-AF trial. 39…”

“…This could be attributed to the significantly higher survival rates of patients with HFmrEF compared with patients with HFrEF in the MISOAC-AF trial. 39 A better understanding of current practice patterns, gaps, and barriers in optimally targeted GDMT delivery is critical for the development of targeted initiatives aimed at improving patient outcomes. Therefore, our data could contribute to explaining physicians' reluctance to achieve target doses, as observed in several registries.…”

Prognostic Impact of Body Mass Index in Atrial Fibrillation

“…Atrial fibrillation (AF) constitutes the most frequently observed cardiac arrhythmia [ 1 ]. AF is a marker of increased risk for stroke, heart failure (HF), ischemic heart disease, or chronic kidney disease [ 2 , 3 , 4 , 5 ]. Obesity, defined by a body mass index (BMI) equal to or greater than 30 kg/m 2 [ 6 ], has gained epidemic proportions with dramatic consequences worldwide mainly due to lifestyle components such as sedentary behavior, physical inactivity, and dietary habits [ 7 , 8 ].…”

Statin Therapy Is Associated With a Lower Risk of Heart Failure in Patients With Atrial Fibrillation: A Population‐Based Study

“… 4 , 5 , 6 , 7 Indeed, HF is becoming a leading cause of hospitalization and nonfatal cardiovascular events in patients with AF, 8 which worsens prognosis in patients with AF. 9 , 10 , 11 Thus, there is a pressing need for preventive strategies to mitigate the burden of HF in patients with AF.…”