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A Kartas, A Samaras, D Vasdeki, G Dividis, G Fotos, E Paschou, E Forozidou, P Tsoukra, E Kotsi, I Goulas, E Karagiannidis, H Karvounis, A Tzikas, G Giannakoulas, Mortality in patients with atrial fibrillation with or without heart failure following hospital discharge, European Heart Journal, Volume 41, Issue Supplement_2, November 2020, ehaa946.0362, https://doi.org/10.1093/ehjci/ehaa946.0362
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Abstract
The association of heart failure (HF) with the prognosis of atrial fibrillation (AF) remains unclear.
OBJECTIVES
To assess all-cause mortality in patients following hospitalization with comorbid AF in relation to the presence of HF.
We performed a cross-sectional analysis of data from 977 patients discharged from the cardiology ward of a single tertiary center between 2015 and 2018 and followed for a median of 2 years. The association between HF and the primary endpoint of death from any cause was assessed using multivariable Cox regression.
HF was documented in 505 (51.7%) of AF cases at discharge, including HFrEF (17.9%), HFmrEF (16.5%) and HFpEF (25.2%). A primary endpoint event occurred in 212 patients (42%) in the AF-HF group and in 86 patients (18.2%) in the AF-no HF group (adjusted hazard ratio [aHR] 2.27; 95% confidence interval [CI], 1.65 to 3.13; P<0.001). HF was associated with a higher risk of the composite secondary endpoint of death from any cause, AF or HF-specific hospitalization (aHR 1.69; 95% CI 1.32 to 2.16 p<0.001). The associations of HF with the primary and secondary endpoints were significant and similar for AF-HFrEF, AF-HFmrEF, AF-HFpEF.
HF was present in half of the patients discharged from the hospital with comorbid AF. The presence of HF on top of AF was independently associated with a significantly higher risk of all-cause mortality than did absence of HF, irrespective of HF subtype.
Table 1
| . | Multivariable adjusted hazard ratio (95% CI) . |
|---|---|
| A. Association between HF and all-cause mortality in patients with AF at hospital discharge | |
| AF-HF | 2.27 (1.65–3.13) |
| AF-HFpEF | 1.94 (1.29–2.92) |
| AF-HFmrEF | 1.86 (1.13–3.07) |
| AF-HFrEF | 3.58 (2.33–5.50) |
| B. Association between HF and the composite endpoint of all-cause mortality, AF or HF-related hospitalization in patients with AF at hospital discharge | |
| AF-HF | 1.69 (1.32–2.16) |
| AF-HFpEF | 1.54 (1.14–2.09) |
| AF-HFmrEF | 1.55 (1.06–2.23) |
| AF-HFrEF | 2.61 (1.84–3.69) |
| . | Multivariable adjusted hazard ratio (95% CI) . |
|---|---|
| A. Association between HF and all-cause mortality in patients with AF at hospital discharge | |
| AF-HF | 2.27 (1.65–3.13) |
| AF-HFpEF | 1.94 (1.29–2.92) |
| AF-HFmrEF | 1.86 (1.13–3.07) |
| AF-HFrEF | 3.58 (2.33–5.50) |
| B. Association between HF and the composite endpoint of all-cause mortality, AF or HF-related hospitalization in patients with AF at hospital discharge | |
| AF-HF | 1.69 (1.32–2.16) |
| AF-HFpEF | 1.54 (1.14–2.09) |
| AF-HFmrEF | 1.55 (1.06–2.23) |
| AF-HFrEF | 2.61 (1.84–3.69) |
Reference category: AF–no HF. Adjustement was made for the following variables: gender, history of smoking, diabetes mellitus, hypertension, coronary artery disease, chronic kidney disease, age, N-terminal pro-BNP, high-sensitivity troponin T.
Type of funding source: None
