Journal of Arrhythmia (Jun 2014)

Impact of atrial fibrillation on long-term clinical outcomes in outpatients with heart failure

  • Hidehiro Kaneko, MD,
  • Shinya Suzuki, MD,
  • Hiroto Kano, MD,
  • Shunsuke Matsuno, MD,
  • Takayuki Otsuka, MD,
  • Hideaki Takai, MD,
  • Tokuhisa Uejima, MD,
  • Yuji Oikawa, MD,
  • Junji Yajima, MD,
  • Akira Koike, MD,
  • Kazuyuki Nagashima, MD,
  • Hajime Kirigaya, MD,
  • Koichi Sagara, MD,
  • Hiroaki Tanabe, MD,
  • Hitoshi Sawada, MD,
  • Tadanori Aizawa, MD,
  • Takeshi Yamashita, MD

DOI
https://doi.org/10.1016/j.joa.2013.10.002
Journal volume & issue
Vol. 30, no. 3
pp. 186 – 191

Abstract

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Background: Atrial fibrillation (AF) is a common arrhythmia in patients with heart failure (HF); however, its impact on unselected outpatients with HF remains unclear. Methods: We followed 2024 symptomatic outpatients with HF who visited the Cardiovascular Institute Hospital (The Shinken Database: 2004–2011, N=17,517). We examined the prevalence, clinical characteristics, and outcomes of AF in these outpatients with HF. Results: AF was observed in 310 of the patients (15%). Patients with AF were older; more likely to be female; and had lower rates of hypertension, diabetes mellitus, and ischemic heart disease. However, they also had higher rates of New York Heart Association grades III/IV, lower left ventricular ejection fraction (EF), renal dysfunction, and dilated cardiomyopathy. The use of cardiovascular drugs including beta-blockers, renin-angiotensin-system inhibitors, diuretics, digitalis, and antiarrhythmic drugs was more common in patients with AF. Kaplan–Meier curves revealed that the incidences of all-cause death, cardiovascular disease death, and HF-related admission were significantly higher in patients with AF. Kaplan–Meier curves and an unadjusted Cox regression analysis showed that AF was associated with a significantly higher risk of all-cause death, cardiovascular death, and HF-related admission. However, the adjusted Cox regression model showed that AF was no longer an independent risk factor for all-cause death, cardiovascular death, and HF death but remained an independent risk factor of HF-related admission (hazard ratio, 1.781; 95% confidence interval, 1.172–2.704; p=0.007). Conclusions: AF was frequently observed in outpatients with HF. AF was not associated with long-term mortality but was independently associated with HF-related admission in this outpatient population.

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