Prognostic implications of atrial fibrillation in heart failure with reduced, mid-range, and preserved ejection fraction: a report from 14 964 patients in the European Society of Cardiology Heart Failure Long-Term Registry

ESC-HFA HF Long-Term Registry Investigators

Research output: Contribution to journalArticle

Abstract

Aim: To investigate the characteristics long-term prognostic implications (up to ∼2.2 years) of atrial fibrillation (AF) compared to sinus rhythm (SR), between acute and chronic heart failure (HF) with reduced (HFrEF < 40%), mid-range (HFmrEF 40-49%), and preserved (HFpEF ≥ 50%) ejection fraction (EF). Methods and results: Data from the observational, prospective, HF long-term registry of the European Society of Cardiology were analysed. A total of 14 964 HF patients (age 66 ± 13 years, 67% male; 53% HFrEF, 21% HFmrEF, 26% HFpEF) were enrolled. The prevalence of AF was 27% in HFrEF, 29% in HFmrEF, and 39% in HFpEF. Atrial fibrillation was associated with older age, lower functional capacity, and heightened physical signs of HF. Crude rates of mortality and HF hospitalization were higher in patients with AF compared to SR, in each EF subtype. After multivariable adjustment, the hazard ratio of AF for HF hospitalizations was: 1.036 (95% CI 0.888-1.208, P = 0.652) in HFrEF, 1.430 (95% CI 1.087-1.882, P = 0.011) in HFmrEF, and 1.487 (95% CI 1.195-1.851, P < 0.001) in HFpEF; and for combined all-cause death or HF hospitalizations: 0.957 (95% CI 0.843-1.087, P = 0.502), 1.302 (95% CI 1.055-1.608, P = 0.014), and 1.365 (95% CI 1.152-1.619, P < 0.001), respectively. In patients with HFrEF, AF was not associated with worse outcomes in those presenting with either an acute or a chronic presentation of HF. Conclusions: The prevalence of AF increases with increasing EF but its association with worse cardiovascular outcomes, remained significant in patients with HFpEF and HFmrEF, but not in those with HFrEF.

Original languageEnglish
Pages (from-to)4277-4284
Number of pages8
JournalEuropean Heart Journal
Volume39
Issue number48
DOIs
Publication statusPublished - Dec 21 2018

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Atrial Fibrillation
Registries
Heart Failure
Hospitalization
Cause of Death
Mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

@article{71d86f47e38142378f0636bc86e9cf14,
title = "Prognostic implications of atrial fibrillation in heart failure with reduced, mid-range, and preserved ejection fraction: a report from 14 964 patients in the European Society of Cardiology Heart Failure Long-Term Registry",
abstract = "Aim: To investigate the characteristics long-term prognostic implications (up to ∼2.2 years) of atrial fibrillation (AF) compared to sinus rhythm (SR), between acute and chronic heart failure (HF) with reduced (HFrEF < 40{\%}), mid-range (HFmrEF 40-49{\%}), and preserved (HFpEF ≥ 50{\%}) ejection fraction (EF). Methods and results: Data from the observational, prospective, HF long-term registry of the European Society of Cardiology were analysed. A total of 14 964 HF patients (age 66 ± 13 years, 67{\%} male; 53{\%} HFrEF, 21{\%} HFmrEF, 26{\%} HFpEF) were enrolled. The prevalence of AF was 27{\%} in HFrEF, 29{\%} in HFmrEF, and 39{\%} in HFpEF. Atrial fibrillation was associated with older age, lower functional capacity, and heightened physical signs of HF. Crude rates of mortality and HF hospitalization were higher in patients with AF compared to SR, in each EF subtype. After multivariable adjustment, the hazard ratio of AF for HF hospitalizations was: 1.036 (95{\%} CI 0.888-1.208, P = 0.652) in HFrEF, 1.430 (95{\%} CI 1.087-1.882, P = 0.011) in HFmrEF, and 1.487 (95{\%} CI 1.195-1.851, P < 0.001) in HFpEF; and for combined all-cause death or HF hospitalizations: 0.957 (95{\%} CI 0.843-1.087, P = 0.502), 1.302 (95{\%} CI 1.055-1.608, P = 0.014), and 1.365 (95{\%} CI 1.152-1.619, P < 0.001), respectively. In patients with HFrEF, AF was not associated with worse outcomes in those presenting with either an acute or a chronic presentation of HF. Conclusions: The prevalence of AF increases with increasing EF but its association with worse cardiovascular outcomes, remained significant in patients with HFpEF and HFmrEF, but not in those with HFrEF.",
author = "{ESC-HFA HF Long-Term Registry Investigators} and Barak Zafrir and Lund, {Lars H.} and Cecile Laroche and Frank Ruschitzka and Crespo-Leiro, {Maria G.} and Coats, {Andrew J.S.} and Anker, {Stefan D.} and Gerasimos Filippatos and Seferovic, {Petar M.} and Maggioni, {Aldo P.} and {De Mora Martin}, Manuel and Lech Polonski and Jos{\'e} Silva-Cardoso and Offer Amir",
year = "2018",
month = "12",
day = "21",
doi = "10.1093/eurheartj/ehy626",
language = "English",
volume = "39",
pages = "4277--4284",
journal = "European Heart Journal",
issn = "0195-668X",
publisher = "Oxford University Press",
number = "48",

}

TY - JOUR

T1 - Prognostic implications of atrial fibrillation in heart failure with reduced, mid-range, and preserved ejection fraction

T2 - a report from 14 964 patients in the European Society of Cardiology Heart Failure Long-Term Registry

AU - ESC-HFA HF Long-Term Registry Investigators

AU - Zafrir, Barak

AU - Lund, Lars H.

AU - Laroche, Cecile

AU - Ruschitzka, Frank

AU - Crespo-Leiro, Maria G.

AU - Coats, Andrew J.S.

AU - Anker, Stefan D.

AU - Filippatos, Gerasimos

AU - Seferovic, Petar M.

AU - Maggioni, Aldo P.

AU - De Mora Martin, Manuel

AU - Polonski, Lech

AU - Silva-Cardoso, José

AU - Amir, Offer

PY - 2018/12/21

Y1 - 2018/12/21

N2 - Aim: To investigate the characteristics long-term prognostic implications (up to ∼2.2 years) of atrial fibrillation (AF) compared to sinus rhythm (SR), between acute and chronic heart failure (HF) with reduced (HFrEF < 40%), mid-range (HFmrEF 40-49%), and preserved (HFpEF ≥ 50%) ejection fraction (EF). Methods and results: Data from the observational, prospective, HF long-term registry of the European Society of Cardiology were analysed. A total of 14 964 HF patients (age 66 ± 13 years, 67% male; 53% HFrEF, 21% HFmrEF, 26% HFpEF) were enrolled. The prevalence of AF was 27% in HFrEF, 29% in HFmrEF, and 39% in HFpEF. Atrial fibrillation was associated with older age, lower functional capacity, and heightened physical signs of HF. Crude rates of mortality and HF hospitalization were higher in patients with AF compared to SR, in each EF subtype. After multivariable adjustment, the hazard ratio of AF for HF hospitalizations was: 1.036 (95% CI 0.888-1.208, P = 0.652) in HFrEF, 1.430 (95% CI 1.087-1.882, P = 0.011) in HFmrEF, and 1.487 (95% CI 1.195-1.851, P < 0.001) in HFpEF; and for combined all-cause death or HF hospitalizations: 0.957 (95% CI 0.843-1.087, P = 0.502), 1.302 (95% CI 1.055-1.608, P = 0.014), and 1.365 (95% CI 1.152-1.619, P < 0.001), respectively. In patients with HFrEF, AF was not associated with worse outcomes in those presenting with either an acute or a chronic presentation of HF. Conclusions: The prevalence of AF increases with increasing EF but its association with worse cardiovascular outcomes, remained significant in patients with HFpEF and HFmrEF, but not in those with HFrEF.

AB - Aim: To investigate the characteristics long-term prognostic implications (up to ∼2.2 years) of atrial fibrillation (AF) compared to sinus rhythm (SR), between acute and chronic heart failure (HF) with reduced (HFrEF < 40%), mid-range (HFmrEF 40-49%), and preserved (HFpEF ≥ 50%) ejection fraction (EF). Methods and results: Data from the observational, prospective, HF long-term registry of the European Society of Cardiology were analysed. A total of 14 964 HF patients (age 66 ± 13 years, 67% male; 53% HFrEF, 21% HFmrEF, 26% HFpEF) were enrolled. The prevalence of AF was 27% in HFrEF, 29% in HFmrEF, and 39% in HFpEF. Atrial fibrillation was associated with older age, lower functional capacity, and heightened physical signs of HF. Crude rates of mortality and HF hospitalization were higher in patients with AF compared to SR, in each EF subtype. After multivariable adjustment, the hazard ratio of AF for HF hospitalizations was: 1.036 (95% CI 0.888-1.208, P = 0.652) in HFrEF, 1.430 (95% CI 1.087-1.882, P = 0.011) in HFmrEF, and 1.487 (95% CI 1.195-1.851, P < 0.001) in HFpEF; and for combined all-cause death or HF hospitalizations: 0.957 (95% CI 0.843-1.087, P = 0.502), 1.302 (95% CI 1.055-1.608, P = 0.014), and 1.365 (95% CI 1.152-1.619, P < 0.001), respectively. In patients with HFrEF, AF was not associated with worse outcomes in those presenting with either an acute or a chronic presentation of HF. Conclusions: The prevalence of AF increases with increasing EF but its association with worse cardiovascular outcomes, remained significant in patients with HFpEF and HFmrEF, but not in those with HFrEF.

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U2 - 10.1093/eurheartj/ehy626

DO - 10.1093/eurheartj/ehy626

M3 - Article

C2 - 30325423

AN - SCOPUS:85058925543

VL - 39

SP - 4277

EP - 4284

JO - European Heart Journal

JF - European Heart Journal

SN - 0195-668X

IS - 48

ER -