Prevalence, Characteristics, and Treatment Strategy of Different Types of Heart Failure in Patients With Nonvalvular Atrial Fibrillation

Abstract

Background Atrial fibrillation (AF) is the most common arrhythmia in patients with heart failure (HF). Epidemiological data regarding HF in patients with AF are lacking. We describe the epidemiology, clinical features, treatment strategies, and in‐hospital outcomes in patients with AF and HF. Methods and Results Patients with HF and nonvalvular AF in the Improving Care for Cardiovascular Disease in China‐AF cohort from February 2015 to December 2019 were included. Patients were stratified by left ventricular ejection fraction into HF with reduced EF, HF with mildly reduced EF, and HF with preserved EF groups. The primary outcome was the occurrence of hospitalization for major adverse cardiovascular events, including death, cardiogenic shock, cardiac arrest, and stroke. Overall, 16 562 patients with AF and HF were included (mean age: 72.35±11.07 years; 46.1% female). HF with preserved EF (63.1%) accounted for the largest proportion, followed by HF with mildly reduced EF (19.0%) and HF with reduced EF (17.9%). Different HF subtypes in patients with AF had unique baseline demographic and clinical characteristics after multinomial logistic regression analysis. Compared with the HF with preserved EF group, hospitalization for major adverse cardiovascular events was increased in the HF with mildly reduced EF group (odds ratio=1.55 [95% CI, 1.18–2.03]) and HF with reduced EF group (odds ratio 1.60 [95% CI, 1.21–2.13]) after adjusting for confounders. Conclusions In this large Chinese AF registry, the distribution of HF differed from the non‐AF population. Patients with AF with different types of HF have unique demographic and clinical characteristics. Occurrence rates of in‐hospital outcomes were higher in patients with HF with mildly reduced EF and patients with HF with reduced EF compared with the HF with preserved EF group. Registration URL: http://www.clinicaltrials.gov; Unique identifier: NCT02309398.

Keywords

• atrial fibrillation
• epidemiology
• heart failure
• outcomes
• quality measures