TY - JOUR
T1 - No decline in the risk of heart failure after incident atrial fibrillation
T2 - A community study assessing trends overall and by ejection fraction
AU - Chamberlain, Alanna M.
AU - Gersh, Bernard J.
AU - Alonso, Alvaro
AU - Kopecky, Stephen L.
AU - Killian, Jill M.
AU - Weston, Susan A.
AU - Roger, Véronique L.
N1 - Publisher Copyright:
© 2017 Heart Rhythm Society
PY - 2017/6
Y1 - 2017/6
N2 - Background Patients with atrial fibrillation (AF) experience an increased risk of heart failure (HF). However, data are lacking on current trends in the risk of HF after AF. Objective The purpose of this study was to describe the temporal trends in HF occurrence after AF in a community cohort of patients with incident AF from 2000 to 2013. Methods Cox regression was used to examine the association of year of AF diagnosis with HF and the predictors of developing HF after AF. Results Among 3491 AF patients without prior HF, 750 (21%) developed incident HF over mean follow-up of 3.7 years. Among those with an echocardiogram, 422 (61%) had HF with preserved ejection fraction (HFpEF), and 270 (39%) had HF with reduced ejection fraction (HFrEF). After adjusting for demographics and comorbidities, the risk of developing HF did not change over time (hazard ratio [HR] (95% confidence interval [CI]) per year of AF diagnosis: 1.01 (0.98–1.03) overall; 1.00 (0.98–1.03) for HFpEF; 1.00 (0.96–1.03) for HFrEF). Increasing age, obesity, smoking, diabetes, chronic pulmonary disease, and renal disease were predictors of developing HF. Compared to the Olmsted County, Minnesota, population, a substantial excess risk of developing HF was observed after AF diagnosis [standardized morbidity ratio (95% CI): 9.60 (7.44–12.19), 2.13 (1.56–2.84), and 1.70 (1.34–2.14) at 90 days, 1 year, and 3 years after diagnosis]. Conclusion In the community, HF is a frequent adverse outcome among patients with AF, and HFpEF is more common than HFrEF. The rates of HF after AF have not declined, thus highlighting the importance of continued efforts to improve outcomes in AF.
AB - Background Patients with atrial fibrillation (AF) experience an increased risk of heart failure (HF). However, data are lacking on current trends in the risk of HF after AF. Objective The purpose of this study was to describe the temporal trends in HF occurrence after AF in a community cohort of patients with incident AF from 2000 to 2013. Methods Cox regression was used to examine the association of year of AF diagnosis with HF and the predictors of developing HF after AF. Results Among 3491 AF patients without prior HF, 750 (21%) developed incident HF over mean follow-up of 3.7 years. Among those with an echocardiogram, 422 (61%) had HF with preserved ejection fraction (HFpEF), and 270 (39%) had HF with reduced ejection fraction (HFrEF). After adjusting for demographics and comorbidities, the risk of developing HF did not change over time (hazard ratio [HR] (95% confidence interval [CI]) per year of AF diagnosis: 1.01 (0.98–1.03) overall; 1.00 (0.98–1.03) for HFpEF; 1.00 (0.96–1.03) for HFrEF). Increasing age, obesity, smoking, diabetes, chronic pulmonary disease, and renal disease were predictors of developing HF. Compared to the Olmsted County, Minnesota, population, a substantial excess risk of developing HF was observed after AF diagnosis [standardized morbidity ratio (95% CI): 9.60 (7.44–12.19), 2.13 (1.56–2.84), and 1.70 (1.34–2.14) at 90 days, 1 year, and 3 years after diagnosis]. Conclusion In the community, HF is a frequent adverse outcome among patients with AF, and HFpEF is more common than HFrEF. The rates of HF after AF have not declined, thus highlighting the importance of continued efforts to improve outcomes in AF.
KW - Atrial fibrillation
KW - Atrial flutter
KW - Epidemiology
KW - Heart failure
KW - Outcomes
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U2 - 10.1016/j.hrthm.2017.01.031
DO - 10.1016/j.hrthm.2017.01.031
M3 - Article
C2 - 28119130
AN - SCOPUS:85015909555
SN - 1547-5271
VL - 14
SP - 791
EP - 798
JO - Heart rhythm
JF - Heart rhythm
IS - 6
ER -