Advertisement

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
First Online:
  • 102 Downloads

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

This is a preview of subscription content, log in to check access.

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)

References

  1. 1.
    Wang TJ, Larson MG, Levy D, Vasan RS, Leip EP, Wolf PA, D’Agostino RB, Murabito JM, Kannel WB, Benjamin EJ (2003) Temporal relations of atrial fibrillation and congestive heart failure and their joint influence on mortality: the Framingham Heart Study. Circulation 107(23):2920–2925.  https://doi.org/10.1161/01.CIR.0000072767.89944.6E CrossRefPubMedGoogle Scholar
  2. 2.
    Santhanakrishnan R, Wang N, Larson MG, Magnani JW, McManus DD, Lubitz SA, Ellinor PT, Cheng S, Vasan RS, Lee DS, Wang TJ, Levy D, Benjamin EJ, Ho JE (2016) Atrial fibrillation begets heart failure and vice versa: temporal associations and differences in preserved versus reduced ejection fraction. Circulation 133(5):484–492.  https://doi.org/10.1161/CIRCULATIONAHA.115.018614 PubMedPubMedCentralCrossRefGoogle Scholar
  3. 3.
    Anter E, Jessup M, Callans DJ (2009) Atrial fibrillation and heart failure: treatment considerations for a dual epidemic. Circulation 119(18):2516–2525.  https://doi.org/10.1161/CIRCULATIONAHA.108.821306 CrossRefPubMedGoogle Scholar
  4. 4.
    Pozzoli M, Cioffi G, Traversi E, Pinna GD, Cobelli F, Tavazzi L (1998) Predictors of primary atrial fibrillation and concomitant clinical and hemodynamic changes in patients with chronic heart failure: a prospective study in 344 patients with baseline sinus rhythm. J Am Coll Cardiol 32(1):197–204CrossRefPubMedGoogle Scholar
  5. 5.
    Li D, Fareh S, Leung TK, Nattel S (1999) Promotion of atrial fibrillation by heart failure in dogs: atrial remodeling of a different sort. Circulation 100(1):87–95CrossRefPubMedGoogle Scholar
  6. 6.
    Solomon SD, Dobson J, Pocock S, Skali H, McMurray JJ, Granger CB, Yusuf S, Swedberg K, Young JB, Michelson EL, Pfeffer MA, Candesartan in Heart failure: Assessment of Reduction in M, morbidity I (2007) Influence of nonfatal hospitalization for heart failure on subsequent mortality in patients with chronic heart failure. Circulation 116(13):1482–1487.  https://doi.org/10.1161/CIRCULATIONAHA.107.696906 CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Owan TE, Hodge DO, Herges RM, Jacobsen SJ, Roger VL, Redfield MM (2006) Trends in prevalence and outcome of heart failure with preserved ejection fraction. N Engl J Med 355(3):251–259.  https://doi.org/10.1056/NEJMoa052256 CrossRefPubMedGoogle Scholar
  8. 8.
    Bhatia RS, Tu JV, Lee DS, Austin PC, Fang J, Haouzi A, Gong Y, Liu PP (2006) Outcome of heart failure with preserved ejection fraction in a population-based study. N Engl J Med 355(3):260–269.  https://doi.org/10.1056/NEJMoa051530 CrossRefPubMedGoogle Scholar
  9. 9.
    Mamas MA, Caldwell JC, Chacko S, Garratt CJ, Fath-Ordoubadi F, Neyses L (2009) A meta-analysis of the prognostic significance of atrial fibrillation in chronic heart failure. Eur J Heart Fail 11(7):676–683.  https://doi.org/10.1093/eurjhf/hfp085 CrossRefPubMedGoogle Scholar
  10. 10.
    Cheng M, Lu X, Huang J, Zhang J, Zhang S, Gu D (2014) The prognostic significance of atrial fibrillation in heart failure with a preserved and reduced left ventricular function: insights from a meta-analysis. Eur J Heart Fail 16(12):1317–1322.  https://doi.org/10.1002/ejhf.187 CrossRefPubMedGoogle Scholar
  11. 11.
    Mountantonakis SE, Grau-Sepulveda MV, Bhatt DL, Hernandez AF, Peterson ED, Fonarow GC (2012) Presence of atrial fibrillation is independently associated with adverse outcomes in patients hospitalized with heart failure: an analysis of get with the guidelines-heart failure. Circ Heart Fail 5(2):191–201.  https://doi.org/10.1161/CIRCHEARTFAILURE.111.965681 CrossRefPubMedGoogle Scholar
  12. 12.
    Mendes FD, Atie J, Garcia MI, Gripp ED, Sousa AS, Feijo LA, Xavier SS (2014) Atrial fibrillation in decompensated heart failure: associated factors and in-hospital outcome. Arq Bras Cardiol 103(4):315–322PubMedCentralGoogle Scholar
  13. 13.
    Abualnaja S, Podder M, Hernandez AF, McMurray JJ, Starling RC, O’Connor CM, Califf RM, Armstrong PW, Ezekowitz JA (2015) Acute heart failure and atrial fibrillation: insights from the acute study of clinical effectiveness of nesiritide in decompensated heart failure (ASCEND-HF) trial. J Am Heart Assoc 4(8):e002092.  https://doi.org/10.1161/JAHA.115.002092 CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, Picard MH, Roman MJ, Seward J, Shanewise JS, Solomon SD, Spencer KT, Sutton MS, Stewart WJ, Chamber Quantification Writing G, American Society of Echocardiography’s G, Standards C, European Association of E (2005) Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 18 (12):1440–1463.  https://doi.org/10.1016/j.echo.2005.10.005 CrossRefPubMedGoogle Scholar
  15. 15.
    Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, Falk V, Gonzalez-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GM, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P, Authors/Task Force M, Document R (2016) 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 18(8):891–975.  https://doi.org/10.1002/ejhf.592 CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Damman K, Tang WH, Testani JM, McMurray JJ (2014) Terminology and definition of changes renal function in heart failure. Eur Heart J 35(48):3413–3416.  https://doi.org/10.1093/eurheartj/ehu320 CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Knol MJ, VanderWeele TJ (2012) Recommendations for presenting analyses of effect modification and interaction. Int J Epidemiol 41(2):514–520.  https://doi.org/10.1093/ije/dyr218 CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Nunez J, Llacer P, Bertomeu-Gonzalez V, Bosch MJ, Merlos P, Garcia-Blas S, Montagud V, Bodi V, Bertomeu-Martinez V, Pedrosa V, Mendizabal A, Cordero A, Gallego J, Palau P, Minana G, Santas E, Morell S, Llacer A, Chorro FJ, Sanchis J, Facila L, Investigators C-H (2016) Carbohydrate antigen-125-guided therapy in acute heart failure: CHANCE-HF: a randomized study. JACC Heart Fail 4(11):833–843.  https://doi.org/10.1016/j.jchf.2016.06.007 CrossRefPubMedGoogle Scholar
  19. 19.
    Teerlink JR, Felker GM, McMurray JJ, Ponikowski P, Metra M, Filippatos GS, Ezekowitz JA, Dickstein K, Cleland JG, Kim JB, Lei L, Knusel B, Wolff AA, Malik FI, Wasserman SM, Investigators A-A (2016) Acute treatment with omecamtiv mecarbil to increase contractility in acute heart failure: the ATOMIC-AHF Study. J Am Coll Cardiol 67(12):1444–1455.  https://doi.org/10.1016/j.jacc.2016.01.031 CrossRefPubMedGoogle Scholar
  20. 20.
    Teerlink JR, Cotter G, Davison BA, Felker GM, Filippatos G, Greenberg BH, Ponikowski P, Unemori E, Voors AA, Adams KF Jr, Dorobantu MI, Grinfeld LR, Jondeau G, Marmor A, Masip J, Pang PS, Werdan K, Teichman SL, Trapani A, Bush CA, Saini R, Schumacher C, Severin TM, Metra M, Investigators REiAHF (2013) Serelaxin, recombinant human relaxin-2, for treatment of acute heart failure (RELAX-AHF): a randomised, placebo-controlled trial. Lancet 381(9860):29–39.  https://doi.org/10.1016/S0140-6736(12)61855-8 CrossRefPubMedGoogle Scholar
  21. 21.
    Bart BA, Goldsmith SR, Lee KL, Givertz MM, O’Connor CM, Bull DA, Redfield MM, Deswal A, Rouleau JL, LeWinter MM, Ofili EO, Stevenson LW, Semigran MJ, Felker GM, Chen HH, Hernandez AF, Anstrom KJ, McNulty SE, Velazquez EJ, Ibarra JC, Mascette AM, Braunwald E, Heart Failure Clinical Research N (2012) Ultrafiltration in decompensated heart failure with cardiorenal syndrome. N Engl J Med 367(24):2296–2304.  https://doi.org/10.1056/NEJMoa1210357 CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Felker GM, Lee KL, Bull DA, Redfield MM, Stevenson LW, Goldsmith SR, LeWinter MM, Deswal A, Rouleau JL, Ofili EO, Anstrom KJ, Hernandez AF, McNulty SE, Velazquez EJ, Kfoury AG, Chen HH, Givertz MM, Semigran MJ, Bart BA, Mascette AM, Braunwald E, O’Connor CM, Network NHFCR (2011) Diuretic strategies in patients with acute decompensated heart failure. N Engl J Med 364(9):797–805.  https://doi.org/10.1056/NEJMoa1005419 CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, Castella M, Diener HC, Heidbuchel H, Hendriks J, Hindricks G, Manolis AS, Oldgren J, Popescu BA, Schotten U, Van Putte B, Vardas P, Agewall S, Camm J, Baron Esquivias G, Budts W, Carerj S, Casselman F, Coca A, De Caterina R, Deftereos S, Dobrev D, Ferro JM, Filippatos G, Fitzsimons D, Gorenek B, Guenoun M, Hohnloser SH, Kolh P, Lip GY, Manolis A, McMurray J, Ponikowski P, Rosenhek R, Ruschitzka F, Savelieva I, Sharma S, Suwalski P, Tamargo JL, Taylor CJ, Van Gelder IC, Voors AA, Windecker S, Zamorano JL, Zeppenfeld K (2016) 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J 37(38):2893–2962.  https://doi.org/10.1093/eurheartj/ehw210 CrossRefPubMedGoogle Scholar
  24. 24.
    Rosenkranz S, Gibbs JS, Wachter R, De Marco T, Vonk-Noordegraaf A, Vachiery JL (2016) Left ventricular heart failure and pulmonary hypertension. Eur Heart J 37(12):942–954.  https://doi.org/10.1093/eurheartj/ehv512 CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Linssen GC, Rienstra M, Jaarsma T, Voors AA, van Gelder IC, Hillege HL, van Veldhuisen DJ (2011) Clinical and prognostic effects of atrial fibrillation in heart failure patients with reduced and preserved left ventricular ejection fraction. Eur J Heart Fail 13(10):1111–1120.  https://doi.org/10.1093/eurjhf/hfr066 CrossRefPubMedGoogle Scholar
  26. 26.
    Goette A, Kalman JM, Aguinaga L, Akar J, Cabrera JA, Chen SA, Chugh SS, Corradi D, A DA, Dobrev D, Fenelon G, Gonzalez M, Hatem SN, Helm R, Hindricks G, Ho SY, Hoit B, Jalife J, Kim YH, Lip GY, Ma CS, Marcus GM, Murray K, Nogami A, Sanders P, Uribe W, Van Wagoner DR, Nattel S, Document Reviewers: Osmar A. Centurion K-HKKKPJLSMSJHS, Gaurav AU, Review coordinator: Alena S (2016) EHRA/HRS/APHRS/SOLAECE expert consensus on Atrial cardiomyopathies: definition, characterisation, and clinical implication. J Arrhythm 32(4):247–278.  https://doi.org/10.1016/j.joa.2016.05.002 CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Calkins H, Reynolds MR, Spector P, Sondhi M, Xu Y, Martin A, Williams CJ, Sledge I (2009) Treatment of atrial fibrillation with antiarrhythmic drugs or radiofrequency ablation: two systematic literature reviews and meta-analyses. Circ Arrhythm Electrophysiol 2(4):349–361.  https://doi.org/10.1161/CIRCEP.108.824789 CrossRefPubMedGoogle Scholar
  28. 28.
    Wilber DJ, Pappone C, Neuzil P, De Paola A, Marchlinski F, Natale A, Macle L, Daoud EG, Calkins H, Hall B, Reddy V, Augello G, Reynolds MR, Vinekar C, Liu CY, Berry SM, Berry DA, ThermoCool AFTI (2010) Comparison of antiarrhythmic drug therapy and radiofrequency catheter ablation in patients with paroxysmal atrial fibrillation: a randomized controlled trial. JAMA 303(4):333–340.  https://doi.org/10.1001/jama.2009.2029 CrossRefPubMedGoogle Scholar
  29. 29.
    Cosedis Nielsen J, Johannessen A, Raatikainen P, Hindricks G, Walfridsson H, Kongstad O, Pehrson S, Englund A, Hartikainen J, Mortensen LS, Hansen PS (2012) Radiofrequency ablation as initial therapy in paroxysmal atrial fibrillation. N Engl J Med 367(17):1587–1595.  https://doi.org/10.1056/NEJMoa1113566 CrossRefPubMedGoogle Scholar
  30. 30.
    Arbelo E, Brugada J, Hindricks G, Maggioni AP, Tavazzi L, Vardas P, Laroche C, Anselme F, Inama G, Jais P, Kalarus Z, Kautzner J, Lewalter T, Mairesse GH, Perez-Villacastin J, Riahi S, Taborsky M, Theodorakis G, Trines SA, Atrial Fibrillation Ablation Pilot Study I (2014) The atrial fibrillation ablation pilot study: a European Survey on Methodology and results of catheter ablation for atrial fibrillation conducted by the European Heart Rhythm Association. Eur Heart J 35(22):1466–1478.  https://doi.org/10.1093/eurheartj/ehu001 CrossRefPubMedGoogle Scholar
  31. 31.
    Marrouche NF, Brachmann J, Andresen D, Siebels J, Boersma L, Jordaens L, Merkely B, Pokushalov E, Sanders P, Proff J, Schunkert H, Christ H, Vogt J, Bansch D, Investigators C-A (2018) Catheter ablation for atrial fibrillation with heart failure. N Engl J Med 378(5):417–427.  https://doi.org/10.1056/NEJMoa1707855 CrossRefPubMedGoogle Scholar
  32. 32.
    Machino-Ohtsuka T, Seo Y, Ishizu T, Sugano A, Atsumi A, Yamamoto M, Kawamura R, Machino T, Kuroki K, Yamasaki H, Igarashi M, Sekiguchi Y, Aonuma K (2013) Efficacy, safety, and outcomes of catheter ablation of atrial fibrillation in patients with heart failure with preserved ejection fraction. J Am Coll Cardiol 62(20):1857–1865.  https://doi.org/10.1016/j.jacc.2013.07.020 CrossRefPubMedGoogle Scholar
  33. 33.
    Kotecha D, Lam CS, Van Veldhuisen DJ, Van Gelder IC, Voors AA, Rienstra M (2016) Heart failure with preserved ejection fraction and atrial fibrillation: vicious twins. J Am Coll Cardiol 68(20):2217–2228.  https://doi.org/10.1016/j.jacc.2016.08.048 CrossRefPubMedGoogle Scholar
  34. 34.
    Melenovsky V, Hwang SJ, Redfield MM, Zakeri R, Lin G, Borlaug BA (2015) Left atrial remodeling and function in advanced heart failure with preserved or reduced ejection fraction. Circ Heart Fail 8(2):295–303.  https://doi.org/10.1161/CIRCHEARTFAILURE.114.001667 CrossRefPubMedGoogle Scholar
  35. 35.
    Hof IE, Velthuis BK, Chaldoupi SM, Wittkampf FH, van Driel VJ, van der Heijden JF, Cramer MJ, Meine M, Hauer RN, Loh P (2011) Pulmonary vein antrum isolation leads to a significant decrease of left atrial size. Europace 13(3):371–375.  https://doi.org/10.1093/europace/euq464 CrossRefPubMedGoogle Scholar
  36. 36.
    Pump A, Di Biase L, Price J, Mohanty P, Bai R, Santangeli P, Mohanty S, Trivedi C, Yan RX, Horton R, Sanchez JE, Zagrodzky J, Bailey S, Gallinghouse GJ, Burkhardt JD, Natale A (2013) Efficacy of catheter ablation in nonparoxysmal atrial fibrillation patients with severe enlarged left atrium and its impact on left atrial structural remodeling. J Cardiovasc Electrophysiol 24(11):1224–1231.  https://doi.org/10.1111/jce.12253 CrossRefPubMedGoogle Scholar

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

Personalised recommendations

Cite article

Buy options