Prevalence and incidence of atrial fibrillation in ambulatory patients with heart failure

Pellicori, P. , Urbinati, A., Kaur, K., Zhang, J., Shah, P., Kazmi, S., Capucci, A., Cleland, J. G.F. and Clark, A. L. (2019) Prevalence and incidence of atrial fibrillation in ambulatory patients with heart failure. American Journal of Cardiology, 124(10), pp. 1554-1560. (doi: 10.1016/j.amjcard.2019.08.018) (PMID:31558271)

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Abstract

Heart failure (HF) and atrial fibrillation (AF) commonly co-exist. We aimed to determine the prevalence and incidence of AF in ambulatory patients with HF. HF was defined by the presence of symptoms or signs supported by objective evidence of cardiac dysfunction: either a left ventricular ejection fraction (LVEF) ≤45% (HF and a reduced ejection fraction, HFrEF), or LVEF >45% and a raised plasma concentration of amino-terminal pro-B type natriuretic peptide (NT-proBNP >220 ng/L; HFpEF). Of 3,570 patients with HF, 1,164 were in AF at baseline (33%), with a higher prevalence among patients with HFpEF compared with HFrEF (40% vs 26%, respectively, p <0.001). Compared with patients with HF in sinus rhythm, those in AF were older, had more severe symptoms and higher NT-proBNP, worse renal function, and were more likely to receive loop diuretics, despite having a higher LVEF. Of those in sinus rhythm, 1,372 patients had HFrEF and 1,034 had HFpEF. The incidence of AF at 1 year (3.0%) was similar for each phenotype (p = 0.73). Increasing age, male gender, history of paroxysmal AF, and higher plasma concentrations of NT-proBNP were independent predictors of incident AF during a median follow-up of 1,574 (interquartile range: 749 to 2,821) days; the predictors were similar for each phenotype. In conclusion, the prevalence of AF is high, especially in patients with HFpEF, but its incidence is modest. This may be because their onset is near simultaneous with the development of AF precipitating the onset of HF.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Cleland, Professor John and Pellicori, Dr Pierpaolo
Authors: Pellicori, P., Urbinati, A., Kaur, K., Zhang, J., Shah, P., Kazmi, S., Capucci, A., Cleland, J. G.F., and Clark, A. L.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Robertson Centre
Journal Name:American Journal of Cardiology
Publisher:Elsevier
ISSN:0002-9149
ISSN (Online):1879-1913
Published Online:23 August 2019
Copyright Holders:Copyright © 2019 Elsevier Inc.
First Published:First published in American Journal of Cardiology 124(10):1554-1560
Publisher Policy:Reproduced in accordance with the copyright policy of the publisher

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