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Prognostic significance of atrial fibrillation in acute decompensated heart failure with reduced versus preserved ejection fraction

  • Alexander Jobs
  • Julia Schwind
  • Alexander Katalinic
  • Valentin Babaev
  • Roland Richard Tilz
  • Stefan Rausch
  • Holger Thiele
  • Ingo Eitel
  • Charlotte Eitel
Original Paper

Abstract

Objective

The prognostic impact of atrial fibrillation (AF) in patients with acute decompensated heart failure (ADHF) has not been fully elucidated yet. Aim of the present study was thus to investigate the association of AF with all-cause mortality in patients with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF).

Methods

We performed a retrospective single center study and analyzed data of 1286 patients admitted for ADHF. Patients were grouped according to AF status (i.e., “never AF”, “history of AF”, or “AF on admission”) and type of heart failure. Patient and treatment characteristics were extracted by chart review. The primary outcome of all-cause mortality within 3 years following index hospitalization was determined by death registry linkage.

Results

In total, 529 (41.1%), 215 (16.7%), and 542 (42.1%) patients were grouped as “never AF”, “history of AF”, and “AF on admission”, respectively. With regard to type of heart failure, 558 (43.4%) and 728 (56.6%) had HFrEF and HFpEF, respectively. Compared to “never AF”, “AF on admission” was associated with increased all-cause mortality in an adjusted Cox regression model [hazard ratio, 1.64 (95% confidence interval 1.32–2.04); P < 0.001]. However, this association remained significant only for patients with HFpEF [2.16 (1.58–2.95)], but not for patients with HFrEF [1.18 (0.85–1.63)] in a subgroup analysis (P for effect modification = 0.020).

Conclusions

AF is common in the setting of ADHF and is associated with increased all-cause mortality. However, this association remained significant only in patients with HFpEF, but not in patients with HFrEF.

Keywords

Acute decompensated heart failure Atrial fibrillation Heart failure with reduced ejection fraction Heart failure with preserved ejection fraction 

Abbreviations

ADHF

Acute decompensated heart failure

AF

Atrial fibrillation

CI

Confidence interval

ECG

Electrocardiography

HFpEF

Heart failure with preserved ejection fraction

HFrEF

Heart failure with reduced ejection fraction

HR

Hazard ratio

IQR

Interquartile range

RCT

Randomized controlled trial

Notes

Funding

Sponsored by the University of Lübeck, Germany.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

392_2018_1321_MOESM1_ESM.doc (72 kb)
Supplementary material 1 (DOC 72 KB)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Alexander Jobs
    • 1
    • 2
  • Julia Schwind
    • 1
  • Alexander Katalinic
    • 3
  • Valentin Babaev
    • 3
  • Roland Richard Tilz
    • 1
    • 2
  • Stefan Rausch
    • 1
  • Holger Thiele
    • 4
  • Ingo Eitel
    • 1
    • 2
  • Charlotte Eitel
    • 1
    • 2
  1. 1.Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital Schleswig-HolsteinUniversity Heart Center Lübeck, Medical Clinic IILübeckGermany
  2. 2.German Center for Cardiovascular Research (DZHK)Partner Site Hamburg/Kiel/LübeckLübeckGermany
  3. 3.Institute for Cancer Epidemiology e.V.University of LübeckLübeckGermany
  4. 4.Department of Internal Medicine/CardiologyHeart Center Leipzig, University HospitalLeipzigGermany

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