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No decline in the risk of heart failure after incident atrial fibrillation: A community study assessing trends overall and by ejection fraction.

Abstract：

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.

journal_name

Heart Rhythm

journal_title

Heart rhythm

authors

Chamberlain AM,Gersh BJ,Alonso A,Kopecky SL,Killian JM,Weston SA,Roger VL

doi

10.1016/j.hrthm.2017.01.031

subject

Has Abstract

pub_date

2017-06-01 00:00:00

pages

791-798

issue

6

eissn

1547-5271

issn

1556-3871

pii

S1547-5271(17)30081-4

journal_volume

14

pub_type

杂志文章,多中心研究

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