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Multicenter Study
. 2024 Oct 1:412:132320.
doi: 10.1016/j.ijcard.2024.132320. Epub 2024 Jul 2.

Prevalence and outcomes of heart failure phenotypes in patients with atrial fibrillation

Gregorio Tersalvi  1 , Matthias Bossard  2 , Stefanie Aeschbacher  3 , Andrea Wiencierz  4 , Jürg H Beer  5 , Nicolas Rodondi  6 , Baris F Gencer  7 , Tobias Reichlin  8 , Angelo Auricchio  9 , Peter Ammann  10 , Giorgio Moschovitis  11 , Leo Bonati  12 , Stefan Osswald  3 , Michael Kühne  3 , David Conen  13 , Richard Kobza  14
Affiliations
Multicenter Study

Prevalence and outcomes of heart failure phenotypes in patients with atrial fibrillation

Gregorio Tersalvi et al. Int J Cardiol. .

Abstract

Background: Atrial fibrillation (AF) is common in patients with heart failure (HF). Real-world data about long-term outcomes and rhythm control interventions use in AF patients with and without HF remain scarce.

Methods: AF patients from two prospective, multicentre studies were classified based on the HF status at baseline into: HF with preserved ejection fraction (HFpEF), HF with reduced or mildly reduced ejection fraction (HFrEF/HFmrEF), and no HF. The prespecified primary outcome was risk of HF hospitalisation. Other outcomes of interest included mortality, cardiovascular events, AF progression, and quality of life.

Results: A total of 1265 patients with AF were analysed (mean age 69.6 years, women 27.4%) with a median follow-up of 5.98 years. Patients with HFpEF (n = 126) had a 2.69-fold and patients with HFrEF/HFmrEF (n = 308) had a 2.12-fold increased risk of HF hospitalisation compared to patients without HF (n = 831, p < 0.001). Similar results applied for all-cause and cardiovascular mortality. The risk for AF progression was higher for patients with HFpEF and HFrEF/HFmrEF (6.30 and 6.79 per 100 patient-years, respectively) compared to patients without HF (4.20). The use of rhythm control strategies during follow-up was least in the HFpEF population (4.56 per 100 patient-years) compared to 7.74 in HFrEF/HFmrEF and 8.03 in patients with no HF. With regards to quality of life over time, this was worst among HFpEF patients.

Conclusions: The presence of HFpEF among patients with AF carried a high risk of HF hospitalisations and AF progression, and worse quality of life. Rhythm control interventions were rarely offered to HFpEF patients. These results uncover an unmet need for enhanced therapeutic interventions in patients with AF and HFpEF.

Keywords: Atrial fibrillation; Epidemiology; HFpEF; Heart failure; Quality of life; Rhythm control.

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Conflict of interest statement

Declaration of competing interest MB has received consulting and speaker fees from Abbott Vascular, Abiomed, Amgen, Astra Zeneca, Bayer, Daichii, Mundipharma and SIS Medical. SA received speaker's fees from Roche outside of the submitted work. JHB is supported by the Swiss National Foundation of Science (324730_182328), the Swiss Heart Foundation and Kardio Foundation; he has received grant support and consultation fees through the institution from Bayer, Daiichi Sankyo and Sanofi. TR has received research grants from the Swiss National Science Foundation, the Swiss Heart Foundation, and the sitem insel support fund, all for work outside the submitted study; speaker/consulting honoraria or travel support from Abbott/SJM, AstraZeneca, Brahms, Bayer, Biosense Webster, Biotronik, Boston Scientific, Daiichi Sankyo, Medtronic, Pfizer/ BMS, and Roche, all for work outside the submitted study; and support for his institution's fellowship program from Abbott/SJM, Biosense Webster, Biotronik, Boston Scientific, and Medtronic, for work outside the submitted study. AA is a consultant to Boston Scientific, Cairdac, Corvia, Microport CRM, EPD Philips, Radcliffe Publisher; he received speaker fees from Boston Scientific, Medtronic, and Microport; he participates in clinical trials sponsored by Boston Scientific, Medtronic, EPD Philips; he has intellectual properties with Boston Scientific, Biosense Webster, and Microport CRM. GM has received advisory board or speaker's fees from Astra Zeneca, Bayer, Boehringer Ingelheim, Daiichi Sankyo, Gebro Pharma, Novartis and Vifor. LB reports personal fees and nonfinancial support from Amgen, grants from AstraZeneca, personal fees and nonfinancial support from Bayer, personal fees from Bristol-Myers Squibb, personal fees from Claret Medical, grants from Swiss National Science Foundation, grants from University of Basel, grants from Swiss Heart Foundation, outside the submitted work. DC received speaker fees from Servier, as well as consulting fees from Roche Diagnostics and Trimedics. SO received research grants from the Swiss National Science Foundation and from the Swiss Heart Foundation, research grants from Foundation for CardioVascular Research Basel, research grants from Roche, educational and speaker office grants from Roche, Bayer, Novartis, Sanofi AstraZeneca, Daiichi-Sankyo and Pfizer. MK reports grants from Bayer, grants from Pfizer, grants from Boston Scientific, grants from BMS, grants and personal fees from Daiichi Sankyo. RK received institutional grants from Abbott, Biosense-Webster, Biotronik, Boston-Scientific, Medtronic and Sis Medical and received consultant fees from Biosense-Webster, Biotronik and Medtronic. The remaining authors have no disclosures to report.

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