History of Atrial Fibrillation and Trajectory of Decongestion in Acute Heart Failure

Ravi B. Patel, Muthiah Vaduganathan, Aruna Rikhi, Hrishikesh Chakraborty, Stephen J. Greene, Adrian F. Hernandez, G. Michael Felker, Margaret M. Redfield, Javed Butler, Sanjiv J. Shah

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Objectives: This study sought to characterize the course of decongestion among patients hospitalized for acute heart failure (AHF) by history of atrial fibrillation (AF) and/or atrial flutter (AFL). Background: AF/AFL and chronic heart failure (HF) commonly coexist. Little is known regarding the impact of AF/AFL on relief of congestion among patients who develop AHF. Methods: We pooled patients from 3 randomized trials of AHF conducted within the Heart Failure Network, the DOSE (Diuretic Optimization Strategies) trial, the ROSE (Renal Optimization Strategies) trial, and the CARRESS-HF (Cardiorenal Rescue Study in Acute Decompensated Heart Failure) trial. The association between history of AF/AFL and in-hospital changes in various metrics of congestion was assessed using covariate-adjusted linear and ordinal logistic regression models. Results: Of 750 unique patients, 418 (56%) had a history of AF/AFL. Left ventricular ejection fraction was higher (35% vs. 27%, respectively; p < 0.001), and N-terminal pro–brain natriuretic peptide (NT-proBNP) levels were nonsignificantly lower at baseline (4,210 pg/ml vs. 5,037 pg/ml, respectively; p = 0.27) in patients with AF/AFL. After adjustment of covariates, history of AF/AFL was associated with less substantial loss of weight (−5.7% vs. −6.5%, respectively; p = 0.02) and decrease in NT-proBNP levels (−18.7% vs. −31.3%, respectively; p = 0.003) by 72 or 96 h. History of AF/AFL was also associated with a blunted increase in global sense of well being at 72 or 96 h (p = 0.04). There was no association between history of AF/AFL and change in orthodema congestion score (p = 0.67) or 60-day composite clinical endpoint (all-cause mortality or any rehospitalization; hazard ratio: 1.21; 95% confidence interval: 0.92 to 1.59; p = 0.17). Conclusions: More than half of the patients admitted with AHF had a history of AF/AFL. History of AF/AFL was independently associated with a blunted course of in-hospital decongestion. Further research is required to understand the utility of specific therapies targeting AF/AFL during hospitalization for AHF.

Original languageEnglish (US)
Pages (from-to)47-55
Number of pages9
JournalJACC: Heart Failure
Issue number1
StatePublished - Jan 2019


  • atrial fibrillation
  • atrial flutter
  • body weight
  • decongestion
  • heart failure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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