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
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 . In addition, between different ethnicities, differences exist in prevalence of AF and mortality rate of HF patients .
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).
- Proportions of patients with HFrEF, HFmrEF and HFpEF were 58.8%, 16.2% and 25.1%, respectively.
- With increasing EF across HF subtypes, prevalence of AF significantly increased (28.9% for HFrEF , 39.8% for HFmrEF, 45.2% for HFpEF; P for trend <0.001).
- Patients with AF were older and less likely to be diabetic or current smokers than those without AF. Regarding HF subtype, age and proportion of female patients increased with EF.
- AF was associated with all-cause death in HFpEF patients (adjusted HR, 1.22, 95% CI: 1.02-1.46), but not in HFrEF and HFmrEF patients. AF was associated with CV mortality in patients with HFpEF (HR, 1.55, 95% CI: 1.06-2.27), but not in patients with HFrEF or HFmrEF.
- AF was associated with stroke in HFrEF and HFpEF patients (HR, 1.53 for HFrEF, 95% CI: 1.03–2.29; HR, 1.90 for HFpEF, 95% CI: 1.13–3.20), but not in HFmrEF patients.
- Similar results were observed after propensity score matching analysis.
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.