Atrial Fibrillation Associated with Heart Failure, Stroke and Mortality

Abstract

Atrial Fibrillation (AF) is the most common arrhythmia in the western world. Because AF prevalence rises with age and western populations are increasingly aging, AF has been called a "growing epidemic", especially among older persons, with social and economic consequences. AF may concur to disability and may cluster with other co-existing clinical conditions. AF is an independent risk factor for stroke by increasing the thromboembolic risk profile and is associated with heart failure severity. Among persons with AF, prevalence of stroke, coronary heart disease, peripheral artery disease, cognitive impairment and physical disability is significantly higher. AF is associated with higher risk of mortality through the association with stroke and heart failure: ischemic strokes are more severe if AF is present and AF may represent a marker of more severe heart failure. Independently of other known predictors of mortality, death rates are almost doubled by AF. AF, therefore, is a considerable source of morbidity and mortality, is associated with disability, and is a major determinant of quality of life.

Figure 1.. Prevalence Estimates of AF in the US Population with (white columns) and Without (grey columns) Taking in Account the Increase in Incidence Observed Between 1980 and 2000. Data from Reference.[6]

Figure 2.. Prevalence of AF in Congestive HF Trials, According to the NYHA Class of the Enrolled Population. Modified from Reference.[8]

Figure 3.. Pathophysiological Interactions Between AF and Congestive HF, Modified from Reference.[9]