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. 2024 Sep;13(3):615-630.
doi: 10.1007/s40119-024-00378-1. Epub 2024 Aug 13.

All-Cause Mortality of Atrial Fibrillation and Heart Failure in the Same Patient: Does the Order Matter?

Tímea Papp  1 , György Rokszin  2 , Zoltán Kiss  3 , Dávid Becker  4 , Béla Merkely  4 , Zoltán Járai  5 , András Jánosi  6 , Zoltán Csanádi  7
Affiliations

All-Cause Mortality of Atrial Fibrillation and Heart Failure in the Same Patient: Does the Order Matter?

Tímea Papp et al. Cardiol Ther. 2024 Sep.

Abstract

Introduction: Atrial fibrillation (AF) and heart failure (HF) often coexist due to the common elements of the pathomechanism they share. The potential significance of the order these entities present in the same patient is ill-defined. Herein, we report our results from a nationwide database on the occurrence of various sequences AF and HF may present, the time delays between the two conditions and all-cause mortality associated with different scenarios.

Methods: Patients diagnosed with both AF and HF between 2015 and 2021 were enrolled from the Hungarian National Health Insurance Fund (NHIF) database. The order the two entities followed each other, and the time delay in between were registered. Median survival rates were calculated in AF → HF; HF → AF and simultaneous scenarios.

Results: A total of 109,075 patients were enrolled: 29,937 with AF → HF, 38,171 with HF → AF, and 40,967 diagnosed simultaneously. Time delays between AF → HF and HF → AF were 6 and 10 months, respectively. The median survival was 46 months in the AF → HF, 38 months in the HF → AF, and 21 months in the simultaneous group. Patients with HF → AF, and with simultaneous presentations had 5% and 16% greater mortality risk as compared to the AF → HF sequence, with hazard ratios (95% confidence intervals) of 0.95 (0.93-0.97) and 0.84 (0.82-0.85), respectively (P < 0.0001).

Conclusions: HF occurred significantly earlier after the diagnosis of AF than vice versa. Patients diagnosed simultaneously had the worst, while the AF → HF sequence had the best prognosis. These data should have implications for the intensification of monitoring and therapy in different scenarios.

Keywords: Atrial fibrillation; Heart failure; Mortality risk; Real-world evidence.

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Conflict of interest statement

György Rokszin is employed by the company RxTarget Ltd. His contribution to this study analysis was financially compensated by the Hungarian Society of Cardiology. Béla Merkely reports grants or contracts from Medtronic and Boston Scientific, and personal fees from Biotronik and Abbott. Zoltán Járai reports payment or honoraria from Bayer, Boehringer, Pfizer, Richter Gedeon, Egis, Krka, Berlin Chemie – Menarini, Novo Nordisk, support for attending meetings from Egis, advisory board membership at Novo Nordisk, and board membership at the European Society of Hypertension, Hungarian Society of Hypertension, Hungarian Society of Cardiology. Tímea Papp, Zoltán Kiss, Dávid Becker, Andrási Jánosi and Zoltán Csanádi declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Fig. 1
Fig. 1
Patient identification scheme
Fig. 2
Fig. 2
Kaplan–Meier curves of overall survival according to sequence scenarios
Fig. 3
Fig. 3
a Kaplan–Meier curve of survival below age 65 according to different sequence scenarios. b Kaplan–Meier curve of survival between 65–79 years according to different sequence scenarios. c Kaplan–Meier curve of survival over 79 years according to different sequence scenarios
Fig. 3
Fig. 3
a Kaplan–Meier curve of survival below age 65 according to different sequence scenarios. b Kaplan–Meier curve of survival between 65–79 years according to different sequence scenarios. c Kaplan–Meier curve of survival over 79 years according to different sequence scenarios
Fig. 4
Fig. 4
Forest plot of mortality according to age and sex group when AF is followed by HF
Fig. 5
Fig. 5
Forest plot of mortality according to age and sex group when HF is followed by AF
Fig. 6
Fig. 6
Forest plot of mortality according to age and sex group when AF and HF are diagnosed at the same time
Fig. 7
Fig. 7
Delay between the first and second diagnosis in the two scenarios
Fig. 8
Fig. 8
Time delay until the development of HF after AF in different age groups
Fig. 9
Fig. 9
Time delay until the development of AF after HF in different age groups
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