Open AccessImpact of atrial fibrillation on long‐term clinical outcomes in outpatients with heart failure
Author(s) -
Kaneko Hidehiro,
Suzuki Shinya,
Kano Hiroto,
Matsuno Shunsuke,
Otsuka Takayuki,
Takai Hideaki,
Uejima Tokuhisa,
Oikawa Yuji,
Yajima Junji,
Koike Akira,
Nagashima Kazuyuki,
Kirigaya Hajime,
Sagara Koichi,
Tanabe Hiroaki,
Sawada Hitoshi,
Aizawa Tadanori,
Yamashita Takeshi
Publication year - 2014
Publication title -
journal of arrhythmia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.463
H-Index - 21
eISSN - 1883-2148
pISSN - 1880-4276
DOI - 10.1016/j.joa.2013.10.002
Subject(s) - medicine , heart failure , atrial fibrillation , cardiology , hazard ratio , ejection fraction , proportional hazards model , diabetes mellitus , risk factor , hypertensive heart disease , confidence interval , endocrinology
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.