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A meta‐analysis of the prognostic significance of atrial fibrillation in chronic heart failure
Author(s) -
Mamas Mamas A.,
Caldwell Jane C.,
Chacko Sanoj,
Garratt Clifford J.,
FathOrdoubadi Farzin,
Neyses Ludwig
Publication year - 2009
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1093/eurjhf/hfp085
Subject(s) - medicine , heart failure , atrial fibrillation , meta analysis , odds ratio , observational study , cardiology , confidence interval , randomized controlled trial , adverse effect
Aims Atrial fibrillation (AF) is one of the commonest sustained arrhythmias in chronic heart failure (CHF), although the prognostic implications of the presence of AF in CHF remain controversial. We have therefore performed this meta‐analysis to study the effects of the presence of AF on mortality in CHF patients. Methods and results A systematic MEDLINE search for all randomized trials and observational studies in which the influence of AF on CHF mortality was investigated and meta‐analysis of the mortality data was performed. A total of 16 studies were identified of which 7 were randomized trials and 9 were observational studies including 30 248 and 23 721 patients, respectively. An adjusted meta‐analysis of the data revealed that the presence of AF is associated with an adverse effect on total mortality with an odds ratio (OR) of 1.40 [95% confidence interval (CI) 1.32–1.48, P < 0.0001] in randomized trials and an OR of 1.14 (95% CI 1.03–1.26, P < 0.05) in observational studies. This increase in mortality associated with the presence of AF was observed in subgroups of CHF patients with both preserved and impaired left ventricular (LV) systolic function. Conclusion In conclusion, meta‐analysis of 16 studies involving 53 969 patients suggests that the presence of AF is associated with an adverse prognosis in CHF irrespective of LV systolic function.