Incidence and impact of atrial fibrillation in heart failure patients: real-world data in a large community

Abstract

Aims: The objective of the present study is to assess the bidirectional association between heart failure (HF) and atrial fibrillation (AF) using real-world data.

Methods and results: From an electronic health recording with a population of 3 799 885 adult subjects, those with prevalent or incident HF were selected and followed throughout a study period of 5 years. Prevalence and incidence of AF, and their impact in the risk for acute HF hospitalization, worsening renal function, ischaemic and haemorrhagic stroke, and all-cause mortality were identified. We analysed all incident and prevalent patients with HF and AF, 128 086 patients (S1), and subsequently analysed a subset of patients with incident HF and AF, 57 354 patients (S2). We analysed all incident and prevalent patients with HF and AF, 128 086 patients (S1), and subsequently a subset of patients with incident HF and AF, 57 354 patients (S2). The prevalence of AF was 59 906 (46.7%) of the HF patients, while incidence in the S2 was 231/1000 patients/year. In both cohorts, S1 and S2, AF significantly increases the risk of acute heart failure hospitalization [incidence 79.1/1000 and 97.5/1000 patients/year; HR 1.53 (1.48-1.59 95% CI) and HR 1.32 (1.24-1.41 95% CI), respectively], risk of decreased renal function (eGFR reduced by >20%) [66.2/1000 and 94.0/1000 patients/year; HR 1.13 (1.09-1.18 95% CI) and HR 1.22 (1.14-1.31 95% CI), respectively] and all-cause mortality [203/1000 and 294/1000 patients/year; HR 1.62 (1.58-1.65 95% CI) and HR 1.65 (1.59-1.70 95% CI), respectively]. The number of episodes of hospitalization for acute heart failure was also significantly higher in the AF patients (27 623 vs. 10 036, P < 0.001). However, the risk for ischaemic stroke was reduced in the AF subjects [HR 0.66 (0.63-0.74 95% CI)], probably due to the anticoagulant treatment.

Conclusions: AF is associated with an increment in the risk of episodes of acute heart failure as well as decline of renal function and increment of all-cause mortality.

Keywords: All-cause mortality; Atrial fibrillation; Heart failure; Hospitalization; Renal function; Stroke.

Figure 1

Survival curves with 95^th confidence interval of being free of AF. Panel A, left side (S1) Total population; Panel B right side (S2) New diagnosis of HF.

Figure 2

Risk of hospitalization by AF. Survival curves with 95^th confidence interval. Panel A, left side (S1) Total population (p<0.0001); Panel, right side (S2) New diagnosis of HF (p<0.0001).

Figure 3

Risk of ischemic stroke by AF. Survival curves with 95^th confidence interval and impact of anticoagulant treatment (blue NOAC, green VKA, red untreated). Panel A upper panel left side (S1) Total population (p=0.0035); Panel B upper panel right side (S2) New diagnosis of HF (p<0.0001); Panel C bottom panel left side (S1) Total population (p<0.0001); Panel D bottom panel right side (S2) New diagnosis of HF (p<0.0001).

Figure 4

Risk of eGFR reduction >20%. Survival curves with 95^th confidence interval. Panel A, left side (S1) Total population (p<0.0001); Panel B right side (S2) New diagnosis of HF (p=0.0006).

Figure 5

Risk of all‐cause mortality by AF. Survival curves with 95^th confidence interval. Panel A left side (S1) Total population (p<0.0001); Panel B right side (S2) New diagnosis of HF (p<0.0001).