Prevalence and Impact of Atrial Fibrillation on Patients With Heart Failure

In a recent real-world data study, researchers found atrial fibrillation (AF) was associated with an incremental increase in risk for acute heart failure episodes and renal function declines, as well as an increase in all-cause mortality. The findings were presented in ESC Heart Failure.

Using an electronic health record database, the researchers conducted a primary analysis in 128,086 patients with AF and heart failure, as well as a subset analysis of 57,354 patients with AF and incident heart failure recorded during 5 years of follow-up. The primary end points of the study were prevalence and incidence of AF and associations with acute heart failure, renal function impairment, ischemic and hemorrhagic stroke, and all-cause mortality.

AF Increases Risk for Events in Patients with Heart Failure

According to the report, the prevalence of AF in the primary cohort was 46.7% (n=59,506), and the incidence of AF in the incident heart failure subset was 231 out of 1,000 patients per year. Notably, the authors determined that AF significantly increased the risk of the following:

  • Acute heart failure hospitalization
    • Primary cohort: 79.1 out of 1,000 patients per year (hazard ratio [HR], 1.53; 95% confidence interval [CI], 1.48-1.59)
    • Incident heart failure cohort: 97.5 out of 1,000 patients per year (HR, 1.32; 95% CI, 1.24-1.41)
  • Decreased renal function (defined as >20% reduction in estimated glomerular filtration rate)
    • Primary cohort: 66.2 out of 1,000 patients per year (HR, 1.13; 95% CI, 1.09-1.18)
    • Incident heart failure cohort: 94.0 out of 1,000 patients per year (HR 1.22; 95% CI, 1.14-1.31)
  • All-cause mortality
    • Primary cohort: 203 out of 1,000 patients per year (HR, 1.62; 95% CI, 1.58-1.65)
    • Incident heart failure cohort: 294 out of 1,000 patients per year (HR, 1.65; 95% CI, 1.59-1.70)

Additionally, compared to the total electronic health record population of 3,799,885 subjects, the authors found that patients with AF had a significantly higher number of hospitalizations for acute heart failure (27,623 vs. 10,036; P<.001), but a lower risk for ischemic stroke (HR, 0.66; 95% CI, 0.63-0.74), which the authors theorized was due to anticoagulant treatments.

Ultimately, the authors concluded that AF is a highly prevalent comorbidity in patients with heart failure, particularly in older patients and in males with concomitant hypertension, diabetes, or chronic kidney disease—though heart failure treatment reduced the risk. They suggested that “efforts to reduce the incidence of AF in heart failure patients will result in an increased quality of life and survival.”

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