Comparison of Mortality and Morbidity in Patients With Atrial Fibrillation and Heart Failure With Preserved Versus Decreased Left Ventricular Ejection Fraction

• Published in: The American journal of cardiology Vol. 108; no. 9; pp. 1283 - 1288
• Main Authors: Badheka, Apurva O., MD, Rathod, Ankit, MD, Kizilbash, Mohammad A., MD, Bhardwaj, Aditya, MD, Ali, Omaima, MD, Afonso, Luis, MD, Jacob, Sony, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-11-2011; Elsevier; Elsevier Limited
• Subjects: Age Factors; Aged; Anticoagulants - therapeutic use; Atrial Fibrillation - epidemiology; Biological and medical sciences; Cardiac arrhythmia; Cardiac dysrhythmias; Cardiology. Vascular system; Cardiovascular; Cardiovascular system; Comparative analysis; Disease Progression; Female; Heart; Heart failure; Heart Failure - epidemiology; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Humans; Hypertension - epidemiology; Investigative techniques of hemodynamics; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Morbidity; Mortality; Patient Readmission; Prognosis; Proportional Hazards Models; Randomized Controlled Trials as Topic; Sex Factors; Stroke - epidemiology; Stroke Volume; United States - epidemiology; Warfarin - therapeutic use; United States; Human; Heart failure; Prognosis; Arrhythmia; Atrial fibrillation; Mortality; Cardiovascular disease; Patient; Excitability disorder; Morbidity; Left ventricle; Heart disease; Ventricular ejection; Circulatory system; Hemodynamics; Cardiology; Comparative study; Ejection fraction
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2011.06.045

Almost 50% of patients with congestive heart failure (HF) have preserved ejection fraction (PEF). Data on the effect of HF-PEF on atrial fibrillation outcomes are lacking. We assessed the prognostic significance of HF-PEF in an atrial fibrillation population compared to a systolic heart failure (SHF) population. A post hoc analysis of the National Heart, Lung, and Blood Institute-limited access data set of the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) trial was carried out. The patients with a history of congestive HF and a preserved ejection fraction (EF >50%) were classified as having HF-PEF (n = 320). The patients with congestive HF and a qualitatively depressed EF (EF <50%) were classified as having SHF (n = 402). Cox proportional hazards analysis was performed. The mean follow-up duration was 1,181 ± 534 days/patient. The patients with HF-PEF had lower all-cause mortality (hazard ratio [HR] 0.62, 95% confidence interval [CI] 0.46 to 0.85, p = 0.003) and cardiovascular mortality (HR 0.56, 95% CI 0.38 to 0.84, p = 0.006), with a possible decreased arrhythmic end point (HR 0.39, 95% CI 0.16 to 1.006, p = 0.052) than did the patients with SHF. No differences were observed for ischemic stroke (HR 1.08, 95% CI 0.48 to 2.39, p = 0.86), rehospitalization (HR 0.89, 95% CI 0.75 to 1.07, p = 0.24), or progression to New York Heart Association class III-IV (odds ratio 0.80, 95% CI 0.42 to 1.54, p = 0.522). In conclusion, although patients with HF-PEF have better mortality outcomes than those with SHF, the morbidity appears to be similar.