title: Atrial fibrillation, ischaemic heart disease, and the risk of death in patients with heart failure.
abstract: OBJECTIVE
  Atrial fibrillation (AF) is a risk factor for death in patients with a myocardial infarction, but highly variable results are reported in patients with heart failure. We studied the prognostic impact of AF in heart failure patients with and without ischaemic heart disease.
  
  
  RESULTS
  During a period of 2 years, 3587 patients admitted to hospital because of heart failure were included in this study. All patients were examined by echocardiography and the presence of AF was recorded. Follow-up was available for 8 years. Twenty four percent of those discharged alive from hospital had AF. After 4 and 8 years of follow-up, mortality was higher in patients with AF than in patients without, 56 vs. 52% and 77 vs. 73%, respectively. Cox multivariable regression analysis showed a small but significant importance of AF for long-term mortality [hazard ratio (HR) 1.12, 95% confidence limits (CI), 1.02-1.23, P=0.018]. There was a significant interaction between the importance of AF and the presence of ischaemic heart disease (P=0.034). In patients with AF at the time of discharge and ischaemic heart disease, HR was 1.25 (95% CI: 1.09-1.42) and P<0.001; in patients with AF at discharge and without ischaemic heart disease, HR was 1.01 (95% CI: 0.88-1.16) and P=0.88.
  
  
  CONCLUSIONS
  AF is associated with increased risk of death only in patients with ischaemic heart disease. This finding may explain the variable results of studies of the prognosis associated with AF in heart failure.
authors.affiliation: Department of Cardiology, Bispebjerg University Hospital, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark. odplc@mail.dk
authors.forename: Ole Dyg
authors.initials: OD
authors.lastname: Pedersen
authors.forename: Peter
authors.initials: P
authors.lastname: Søndergaard
authors.forename: Tonny
authors.initials: T
authors.lastname: Nielsen
authors.forename: Søren Junge
authors.initials: SJ
authors.lastname: Nielsen
authors.forename: Eric Steen
authors.initials: ES
authors.lastname: Nielsen
authors.forename: Niels
authors.initials: N
authors.lastname: Falstie-Jensen
authors.forename: Ingolf
authors.initials: I
authors.lastname: Nielsen
authors.forename: Lars
authors.initials: L
authors.lastname: Køber
authors.forename: Hans
authors.initials: H
authors.lastname: Burchardt
authors.forename: Marie
authors.initials: M
authors.lastname: Seibaek
authors.forename: Christian
authors.initials: C
authors.lastname: Torp-Pedersen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000401:mortality*; D003718:Denmark / Q000453:epidemiology; D005260:Female; D006333:Heart Failure / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000401:mortality*; D011379:Prognosis; D012044:Regression Analysis; D012307:Risk Factors