Atrial Fibrillation in Heart Failure: High Mortality Risk
Background: The purpose of this study was to determine if patients with atrial fibrillation (AF) and heart failure (HF) have a better prognosis when systolic function is preserved as compared with those with depressed systolic function.
Methods: Data from consecutive patients presenting to the emergency department at Brigham and Women's Hospital from January 1997 to December 2002 who had a diagnosis of AF and HF and a measure of ejection fraction (EF) were reviewed. Vital status was determined from the Social Security Death Index.
Results: Of 478 patients (mean age 74 ± 13 years; 47% women), EF was preserved (>50%) in 46%. Those with preserved left ventricular (LV) function were older (76 vs 72 years, P < .0020), included more women (62 vs 35%, P < .0001), more likely to have a history of hypertension and pulmonary disease and less likely to have had a prior myocardial infarction. At 5 years, mortality was similar between the preserved and depressed EF groups (50% vs 48%, P = .74). In multivariable analysis, age > 75 years, history of cancer, cerebrovascular disease, aortic valve disease, serum creatinine > 2.0 mg/dL, and serum sodium < 130 mmol/L were associated with increased mortality. Therapy with β-blockers and angiotensin-converting enzyme inhibitors/angiotensin receptor blocker were associated with lower mortality.
Conclusion: Patients who present to the emergency department with AF, HF, and preserved LVEF have a similarly high mortality as compared with those with depressed LVEF. Further study is needed to assess the impact of therapies and clarify the reasons for the poor prognosis.
Atrial fibrillation (AF) accounts for >350000 US hospital admissions annually. It is the most common sustained cardiac arrhythmia, with a prevalence reaching 10% in octogenarians and an incidence that doubles with each advancing decade. Congestive heart failure (HF) is an even larger epidemiologic problem afflicting >5 million North Americans with 550 000 new diagnoses made yearly and over >995000 US hospital admissions annually. Although much attention is paid to patients with depressed left ventricular (LV) function, patients with preserved LV function comprise approximately 40% to 50% of the HF population. With the aging of the US population, this latter group will increase. The prognosis of patients with HF and preserved LV function is considerably worse than in patients without HF and may approach that of HF and depressed LV function.
Atrial fibrillation and HF commonly coexist. Patients with HF, AF, and reduced systolic function have been well studied. Atrial fibrillation is a marker for increased total mortality and death from HF and is associated with a 2-fold increased risk of systemic thromboembolism. The prevalence of AF in HF increases with the severity of LV dysfunction and is as high as 50% in advanced HF with systolic dysfunction.
Atrial fibrillation occurs in 12% to 26% of patients with HF with preserved LV systolic function. Despite its frequency, the prognostic significance of AF in patients with HF with preserved LV function has not been defined. The objective of this study is to determine if the mortality associated with AF in patients with HF and preserved LV systolic function is better than that of patients with HF with depressed systolic function.
Background: The purpose of this study was to determine if patients with atrial fibrillation (AF) and heart failure (HF) have a better prognosis when systolic function is preserved as compared with those with depressed systolic function.
Methods: Data from consecutive patients presenting to the emergency department at Brigham and Women's Hospital from January 1997 to December 2002 who had a diagnosis of AF and HF and a measure of ejection fraction (EF) were reviewed. Vital status was determined from the Social Security Death Index.
Results: Of 478 patients (mean age 74 ± 13 years; 47% women), EF was preserved (>50%) in 46%. Those with preserved left ventricular (LV) function were older (76 vs 72 years, P < .0020), included more women (62 vs 35%, P < .0001), more likely to have a history of hypertension and pulmonary disease and less likely to have had a prior myocardial infarction. At 5 years, mortality was similar between the preserved and depressed EF groups (50% vs 48%, P = .74). In multivariable analysis, age > 75 years, history of cancer, cerebrovascular disease, aortic valve disease, serum creatinine > 2.0 mg/dL, and serum sodium < 130 mmol/L were associated with increased mortality. Therapy with β-blockers and angiotensin-converting enzyme inhibitors/angiotensin receptor blocker were associated with lower mortality.
Conclusion: Patients who present to the emergency department with AF, HF, and preserved LVEF have a similarly high mortality as compared with those with depressed LVEF. Further study is needed to assess the impact of therapies and clarify the reasons for the poor prognosis.
Atrial fibrillation (AF) accounts for >350000 US hospital admissions annually. It is the most common sustained cardiac arrhythmia, with a prevalence reaching 10% in octogenarians and an incidence that doubles with each advancing decade. Congestive heart failure (HF) is an even larger epidemiologic problem afflicting >5 million North Americans with 550 000 new diagnoses made yearly and over >995000 US hospital admissions annually. Although much attention is paid to patients with depressed left ventricular (LV) function, patients with preserved LV function comprise approximately 40% to 50% of the HF population. With the aging of the US population, this latter group will increase. The prognosis of patients with HF and preserved LV function is considerably worse than in patients without HF and may approach that of HF and depressed LV function.
Atrial fibrillation and HF commonly coexist. Patients with HF, AF, and reduced systolic function have been well studied. Atrial fibrillation is a marker for increased total mortality and death from HF and is associated with a 2-fold increased risk of systemic thromboembolism. The prevalence of AF in HF increases with the severity of LV dysfunction and is as high as 50% in advanced HF with systolic dysfunction.
Atrial fibrillation occurs in 12% to 26% of patients with HF with preserved LV systolic function. Despite its frequency, the prognostic significance of AF in patients with HF with preserved LV function has not been defined. The objective of this study is to determine if the mortality associated with AF in patients with HF and preserved LV systolic function is better than that of patients with HF with depressed systolic function.