Does rhythm matter in Acute Heart Failure? an insight from the British Society for Heart Failure National Audit

Simon G. Anderson, Ahmad Shoaib (Corresponding Author), Phyo Kyaw Myint, John G. Cleland, Suzanna M. Hardman, Theresa McDonagh, Henry Dargie, Bernard Keavney, Clifford G. Garratt, Mamas A Mamas (Corresponding Author)

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background

Atrial fibrillation (AF) is the most common sustained arrhythmia in patients with acute heart failure (AHF). The presence of AF is associated with adverse prognosis in patients with chronic heart failure (CHF) but little is known about its impact in AHF.

Methods

Data were collected between April 2007 and March 2013 across 185 (> 95%) hospitals in England and Wales from patients with a primary death or a discharge diagnosis of AHF. We investigated the association between the presence of AF and all-cause mortality during the index hospital admission, at 30 days and 1 year post-discharge.

Results

Of 96,593 patients admitted with AHF, 44,642 (46%) were in sinus rhythm (SR) and 51,951 (54%) in AF. Patients with AF were older (mean age 79.8 (79.7–80) versus 74.7 (74.5–74.7) years; p < 0.001), than those in SR. In a multivariable analysis, AF was independently associated with mortality at all time points, in hospital (HR 1.15, 95% CI 1.09–1.21, p < 0.0001), 30 days (HR 1.13, 95% CI 1.08–1.19, p < 0.0001), and 1 year (HR 1.09, 95% CI 1.05–1.12, p < 0.0001). In subgroup analyses, AF was independently associated with worse 30-day outcome irrespective of sex, ventricular phenotype and in all age groups except in those aged between 55 and 74 years.

Conclusion

AF is independently associated with adverse prognosis in AHF during admission and up to 1 year post-discharge. As the clinical burden of concomitant AF and AHF increases, further refinement in the detection, treatment and prevention of AF-related complications may have a role in improving patient outcomes.

Original languageEnglish
Number of pages11
JournalClinical Research in Cardiology
Early online date8 Apr 2019
DOIs
Publication statusE-pub ahead of print - 8 Apr 2019

Fingerprint

Heart Failure
Mortality
Wales
England
Cardiac Arrhythmias
Age Groups
Phenotype

Keywords

  • acute heart failure
  • atrial fibrillation
  • prognosis
  • mortality
  • Prognosis
  • Atrial fibrillation
  • Mortality
  • Acute heart failure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Does rhythm matter in Acute Heart Failure? an insight from the British Society for Heart Failure National Audit. / Anderson, Simon G.; Shoaib, Ahmad (Corresponding Author); Myint, Phyo Kyaw; Cleland, John G.; Hardman, Suzanna M.; McDonagh, Theresa; Dargie, Henry; Keavney, Bernard; Garratt, Clifford G.; Mamas, Mamas A (Corresponding Author).

In: Clinical Research in Cardiology, 08.04.2019.

Research output: Contribution to journalArticle

Anderson, Simon G. ; Shoaib, Ahmad ; Myint, Phyo Kyaw ; Cleland, John G. ; Hardman, Suzanna M. ; McDonagh, Theresa ; Dargie, Henry ; Keavney, Bernard ; Garratt, Clifford G. ; Mamas, Mamas A. / Does rhythm matter in Acute Heart Failure? an insight from the British Society for Heart Failure National Audit. In: Clinical Research in Cardiology. 2019.
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abstract = "BackgroundAtrial fibrillation (AF) is the most common sustained arrhythmia in patients with acute heart failure (AHF). The presence of AF is associated with adverse prognosis in patients with chronic heart failure (CHF) but little is known about its impact in AHF.MethodsData were collected between April 2007 and March 2013 across 185 (> 95{\%}) hospitals in England and Wales from patients with a primary death or a discharge diagnosis of AHF. We investigated the association between the presence of AF and all-cause mortality during the index hospital admission, at 30 days and 1 year post-discharge.ResultsOf 96,593 patients admitted with AHF, 44,642 (46{\%}) were in sinus rhythm (SR) and 51,951 (54{\%}) in AF. Patients with AF were older (mean age 79.8 (79.7–80) versus 74.7 (74.5–74.7) years; p < 0.001), than those in SR. In a multivariable analysis, AF was independently associated with mortality at all time points, in hospital (HR 1.15, 95{\%} CI 1.09–1.21, p < 0.0001), 30 days (HR 1.13, 95{\%} CI 1.08–1.19, p < 0.0001), and 1 year (HR 1.09, 95{\%} CI 1.05–1.12, p < 0.0001). In subgroup analyses, AF was independently associated with worse 30-day outcome irrespective of sex, ventricular phenotype and in all age groups except in those aged between 55 and 74 years.ConclusionAF is independently associated with adverse prognosis in AHF during admission and up to 1 year post-discharge. As the clinical burden of concomitant AF and AHF increases, further refinement in the detection, treatment and prevention of AF-related complications may have a role in improving patient outcomes.",
keywords = "acute heart failure, atrial fibrillation, prognosis, mortality, Prognosis, Atrial fibrillation, Mortality, Acute heart failure",
author = "Anderson, {Simon G.} and Ahmad Shoaib and Myint, {Phyo Kyaw} and Cleland, {John G.} and Hardman, {Suzanna M.} and Theresa McDonagh and Henry Dargie and Bernard Keavney and Garratt, {Clifford G.} and Mamas, {Mamas A}",
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T1 - Does rhythm matter in Acute Heart Failure? an insight from the British Society for Heart Failure National Audit

AU - Anderson, Simon G.

AU - Shoaib, Ahmad

AU - Myint, Phyo Kyaw

AU - Cleland, John G.

AU - Hardman, Suzanna M.

AU - McDonagh, Theresa

AU - Dargie, Henry

AU - Keavney, Bernard

AU - Garratt, Clifford G.

AU - Mamas, Mamas A

PY - 2019/4/8

Y1 - 2019/4/8

N2 - BackgroundAtrial fibrillation (AF) is the most common sustained arrhythmia in patients with acute heart failure (AHF). The presence of AF is associated with adverse prognosis in patients with chronic heart failure (CHF) but little is known about its impact in AHF.MethodsData were collected between April 2007 and March 2013 across 185 (> 95%) hospitals in England and Wales from patients with a primary death or a discharge diagnosis of AHF. We investigated the association between the presence of AF and all-cause mortality during the index hospital admission, at 30 days and 1 year post-discharge.ResultsOf 96,593 patients admitted with AHF, 44,642 (46%) were in sinus rhythm (SR) and 51,951 (54%) in AF. Patients with AF were older (mean age 79.8 (79.7–80) versus 74.7 (74.5–74.7) years; p < 0.001), than those in SR. In a multivariable analysis, AF was independently associated with mortality at all time points, in hospital (HR 1.15, 95% CI 1.09–1.21, p < 0.0001), 30 days (HR 1.13, 95% CI 1.08–1.19, p < 0.0001), and 1 year (HR 1.09, 95% CI 1.05–1.12, p < 0.0001). In subgroup analyses, AF was independently associated with worse 30-day outcome irrespective of sex, ventricular phenotype and in all age groups except in those aged between 55 and 74 years.ConclusionAF is independently associated with adverse prognosis in AHF during admission and up to 1 year post-discharge. As the clinical burden of concomitant AF and AHF increases, further refinement in the detection, treatment and prevention of AF-related complications may have a role in improving patient outcomes.

AB - BackgroundAtrial fibrillation (AF) is the most common sustained arrhythmia in patients with acute heart failure (AHF). The presence of AF is associated with adverse prognosis in patients with chronic heart failure (CHF) but little is known about its impact in AHF.MethodsData were collected between April 2007 and March 2013 across 185 (> 95%) hospitals in England and Wales from patients with a primary death or a discharge diagnosis of AHF. We investigated the association between the presence of AF and all-cause mortality during the index hospital admission, at 30 days and 1 year post-discharge.ResultsOf 96,593 patients admitted with AHF, 44,642 (46%) were in sinus rhythm (SR) and 51,951 (54%) in AF. Patients with AF were older (mean age 79.8 (79.7–80) versus 74.7 (74.5–74.7) years; p < 0.001), than those in SR. In a multivariable analysis, AF was independently associated with mortality at all time points, in hospital (HR 1.15, 95% CI 1.09–1.21, p < 0.0001), 30 days (HR 1.13, 95% CI 1.08–1.19, p < 0.0001), and 1 year (HR 1.09, 95% CI 1.05–1.12, p < 0.0001). In subgroup analyses, AF was independently associated with worse 30-day outcome irrespective of sex, ventricular phenotype and in all age groups except in those aged between 55 and 74 years.ConclusionAF is independently associated with adverse prognosis in AHF during admission and up to 1 year post-discharge. As the clinical burden of concomitant AF and AHF increases, further refinement in the detection, treatment and prevention of AF-related complications may have a role in improving patient outcomes.

KW - acute heart failure

KW - atrial fibrillation

KW - prognosis

KW - mortality

KW - Prognosis

KW - Atrial fibrillation

KW - Mortality

KW - Acute heart failure

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