title: Atrial fibrillation in heart failure: high mortality risk even if ventricular function is preserved.
abstract: BACKGROUND
  The purpose of this study was to determine if patients with atrial fibrillation (AF) and heart failure (HF) have a better prognosis when systolic function is preserved as compared with those with depressed systolic function.
  
  
  METHODS
  Data from consecutive patients presenting to the emergency department at Brigham and Women's Hospital from January 1997 to December 2002 who had a diagnosis of AF and HF and a measure of ejection fraction (EF) were reviewed. Vital status was determined from the Social Security Death Index.
  
  
  RESULTS
  Of 478 patients (mean age 74 +/- 13 years; 47% women), EF was preserved (> 50%) in 46%. Those with preserved left ventricular (LV) function were older (76 vs 72 years, P < .0020), included more women (62 vs 35%, P < .0001), more likely to have a history of hypertension and pulmonary disease and less likely to have had a prior myocardial infarction. At 5 years, mortality was similar between the preserved and depressed EF groups (50% vs 48%, P = .74). In multivariable analysis, age > 75 years, history of cancer, cerebrovascular disease, aortic valve disease, serum creatinine > 2.0 mg/dL, and serum sodium < 130 mmol/L were associated with increased mortality. Therapy with beta-blockers and angiotensin-converting enzyme inhibitors/angiotensin receptor blocker were associated with lower mortality.
  
  
  CONCLUSIONS
  Patients who present to the emergency department with AF, HF, and preserved LVEF have a similarly high mortality as compared with those with depressed LVEF. Further study is needed to assess the impact of therapies and clarify the reasons for the poor prognosis.
authors.affiliation: Division of Cardiology, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada. ratica.parkash@cdha.nshealth.ca
authors.forename: Ratika
authors.initials: R
authors.lastname: Parkash
authors.forename: William H
authors.initials: WH
authors.lastname: Maisel
authors.forename: F Michael
authors.initials: FM
authors.lastname: Toca
authors.forename: William G
authors.initials: WG
authors.lastname: Stevenson
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications* / Q000401:mortality* / Q000503:physiopathology; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000401:mortality* / Q000503:physiopathology; D006801:Humans; D008297:Male; D011379:Prognosis; D012307:Risk Factors; D016277:Ventricular Function, Left