Atrial fibrillation and risk of progressive heart failure in patients with preserved ejection fraction heart failure

Atrial fibrillation and risk of progressive heart failure in patients with preserved ejection fraction heart failure

Aims Understanding of the pathophysiology of progressive heart failure (HF) in patients with heart failure with preserved ejection fraction (HFpEF) is incomplete. We sought to identify factors differentially associated with risk of progressive HF death and hospitalization in patients with HFpEF comp...

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Published in:ESC Heart Failure Vol. 9; no. 5; pp. 3254 - 3263
Main Authors: Gierula, John, Cole, Charlotte A., Drozd, Michael, Lowry, Judith E., Straw, Sam, Slater, Thomas A., Paton, Maria F., Byrom, Rowenna J., Garland, Ellis, Halliday, Georgia, Winsor, Sarah, Lyall, Gemma K., Birch, Karen, McGinlay, Melanie, Sunley, Emma, Grant, Peter J., Wessels, David H., Ketiar, Elias M., Witte, Klaus K., Cubbon, Richard M., Kearney, Mark T.
Format: Journal Article
Language:English
Published: England John Wiley & Sons, Inc 01-10-2022
John Wiley and Sons Inc
Wiley
Subjects:
Atrial fibrillation
Atrial Fibrillation - complications
Atrial Fibrillation - epidemiology
Blood pressure
Cardiac arrhythmia
Cardiology
Cardiovascular disease
Diuretics
Ejection fraction
Electrocardiography
Heart failure
Heart Failure - complications
Heart Failure - diagnosis
Heart Failure - epidemiology
Heart failure preserved ejection fraction
Heart Failure, Diastolic - complications
Hospitalization
Humans
Hypertension
Ischemia
Laboratories
Medical prognosis
Mortality
Original
Patients
Primary care
Prognosis
Progressive heart failure
Prospective Studies
Stroke Volume - physiology
Progressive heart failure
Atrial fibrillation
Heart failure preserved ejection fraction
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Summary:Aims Understanding of the pathophysiology of progressive heart failure (HF) in patients with heart failure with preserved ejection fraction (HFpEF) is incomplete. We sought to identify factors differentially associated with risk of progressive HF death and hospitalization in patients with HFpEF compared with patients with HF and reduced ejection fraction (HFrEF). Methods and results Prospective cohort study of patients newly referred to secondary care with suspicion of HF, based on symptoms and signs of HF and elevated natriuretic peptides (NP), followed up for a minimum of 6 years. HFpEF and HFrEF were diagnosed according to the 2016 European Society of Cardiology guidelines. Of 960 patients referred, 467 had HFpEF (49%), 311 had HFrEF (32%), and 182 (19%) had neither. Atrial fibrillation (AF) was found in 37% of patients with HFpEF and 34% with HFrEF. During 6 years follow‐up, 19% of HFrEF and 14% of HFpEF patients were hospitalized or died due to progressive HF, hazard ratio (HR) 0.67 (95% CI: 0.47–0.96; P = 0.028). AF was the only marker that was differentially associated with progressive HF death or hospitalization in patients with HFpEF HR 2.58 (95% CI: 1.59–4.21; P < 0.001) versus HFrEF HR 1.11 (95% CI: 0.65–1.89; P = 0.7). Conclusions De novo patients diagnosed with HFrEF have greater risk of death or hospitalization due to progressive HF than patients with HFpEF. AF is associated with increased risk of progressive HF death or hospitalization in HFpEF but not HFrEF, raising the intriguing possibility that this may be a novel therapeutic target in this growing population.
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ISSN:2055-5822
2055-5822
DOI:10.1002/ehf2.14004