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)

*Corresponding author for this work

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4 Citations (Scopus)
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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
Pages (from-to)1276-1286
Number of pages11
JournalClinical Research in Cardiology
Volume108
Issue number11
Early online date8 Apr 2019
DOIs
Publication statusPublished - Nov 2019

Keywords

  • acute heart failure
  • atrial fibrillation
  • prognosis
  • mortality
  • Prognosis
  • Atrial fibrillation
  • Mortality
  • Acute heart failure
  • METAANALYSIS
  • MANAGEMENT
  • PREVENTION
  • RISK
  • INHIBITION
  • RENIN-ANGIOTENSIN SYSTEM
  • EJECTION FRACTION
  • PAROXYSMAL ATRIAL-FIBRILLATION
  • PROGNOSTIC-SIGNIFICANCE
  • BETA-BLOCKERS

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  • Cite this

    Anderson, S. G., Shoaib, A., Myint, P. K., Cleland, J. G., Hardman, S. M., McDonagh, T., Dargie, H., Keavney, B., Garratt, C. G., & Mamas, M. A. (2019). Does rhythm matter in acute heart failure? An insight from the British Society for Heart Failure National Audit. Clinical Research in Cardiology, 108(11), 1276-1286. https://doi.org/10.1007/s00392-019-01463-5