Physicians' Academy for Cardiovascular Education

AF associated with increased CV and total mortality in East Asian HFpEF patients

Impact of atrial fibrillation in patients with heart failure and reduced, mid-range or preserved ejection fraction

Literature - Son MK, Park JJ, Lim N-K et al. - Heart. 2020. doi:10.1136/heartjnl-2019-316219

Introduction and methods

AF and HF frequently coexist in patients due to their common risk factors, and these patients have a worse prognosis than patients with either AF or HF alone [1-3]. However, it remains controversial whether AF has prognostic value in patients with HF. Although data from different studies and meta-analyses show that AF is associated with higher mortality in patients with HFpEF and HFrEF [4-11], the HF long-term registry of the European Society of Cardiology found no association between AF and poor outcomes in HFrEF patients [12]. In addition, between different ethnicities, differences exist in prevalence of AF and mortality rate of HF patients [13].

The present study evaluated the clinical characteristics and prognostic impact of AF in HF patients in the Korean Acute Heart Failure (KorAHF) registry. Included patients (n=5414) were hospitalized with acute HF at 10 different Korean hospitals from March 2011 to February 2014 [14, 15]. Patients were categorized according to LVEF subtype, including HFrEF with EF <40%, HFmrEF (mid-range EF) with EF 40%–49% and HFpEF with EF ≥50%. AF was confirmed by ECG during index admission. Primary outcomes were defined as all-cause mortality, composite of all-cause mortality and readmission for HF, CV mortality and stroke during the follow-up period. Data were collected until December 2018, with at least 3 years of follow up data of all patients. Median follow-up was 4.03 years (IQR: 1.39-5.58).

Main results


This study of acute HF patients in a Korean registry showed that, with increasing EF across HF subtypes, prevalence of AF increased. In addition, AF was associated with increased CV and total mortality in HFpEF patients and increased risk of stroke in both HFrEF and HFpEF patients.


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