Does rhythm matter in acute heart failure? An insight from the British Society for Heart Failure National Audit

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

doi:10.1007/s00392-019-01463-5

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

Research output: Contribution to journal › Article › peer-review

6 Citations (Scopus)

3 Downloads (Pure)

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 language	English
Pages (from-to)	1276-1286
Number of pages	11
Journal	Clinical Research in Cardiology
Volume	108
Issue number	11
Early online date	8 Apr 2019
DOIs	https://doi.org/10.1007/s00392-019-01463-5
Publication status	Published - 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

Access to Document

10.1007/s00392-019-01463-5Licence: CC BY

Anderson2019_Article_DoesRhythmMatterInAcuteHeartFa_VOR
This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
Final published version, 869 KBLicence: CC BY

Cite this

@article{4e4670c35afc445cbe09feef5600f8a4,

title = "Does rhythm matter in acute heart failure? An insight from the British Society for Heart Failure National Audit",

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, METAANALYSIS, MANAGEMENT, PREVENTION, RISK, INHIBITION, RENIN-ANGIOTENSIN SYSTEM, EJECTION FRACTION, PAROXYSMAL ATRIAL-FIBRILLATION, PROGNOSTIC-SIGNIFICANCE, BETA-BLOCKERS",

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}",

year = "2019",

month = nov,

doi = "10.1007/s00392-019-01463-5",

language = "English",

volume = "108",

pages = "1276--1286",

journal = "Clinical Research in Cardiology",

issn = "1861-0684",

publisher = "Springer ",

number = "11",

}

TY - JOUR

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 - 2019/11

Y1 - 2019/11

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

KW - METAANALYSIS

KW - MANAGEMENT

KW - PREVENTION

KW - RISK

KW - INHIBITION

KW - RENIN-ANGIOTENSIN SYSTEM

KW - EJECTION FRACTION

KW - PAROXYSMAL ATRIAL-FIBRILLATION

KW - PROGNOSTIC-SIGNIFICANCE

KW - BETA-BLOCKERS

UR - http://www.scopus.com/inward/record.url?scp=85064273114&partnerID=8YFLogxK

UR - http://www.mendeley.com/research/rhythm-matter-acute-heart-failure-insight-british-society-heart-failure-national-audit

U2 - 10.1007/s00392-019-01463-5

DO - 10.1007/s00392-019-01463-5

M3 - Article

C2 - 30963233

VL - 108

SP - 1276

EP - 1286

JO - Clinical Research in Cardiology

JF - Clinical Research in Cardiology

SN - 1861-0684

IS - 11

ER -

Does rhythm matter in acute heart failure? An insight from the British Society for Heart Failure National Audit

Abstract

Keywords

Access to Document

Other files and links

Fingerprint

Cite this