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