Atrial fibrillation in heart failure patients: prevalence in daily practice and effect on the severity of symptoms. Data from the ALPHA study registry.
BACKGROUND
Estimates of the prevalence of atrial fibrillation (AF) in heart failure (HF) originate from patients enrolled in clinical trials.


OBJECTIVE
To assess the prevalence and clinical correlates of AF among HF patients in everyday clinical practice from HF patients screened for the T-wave ALternans in Patients with Heart fAilure (ALPHA) study; to investigate the correlation between AF and functional status.


RESULTS
Consecutive patients (N=3513) seen at nine Heart Failure Clinics were studied; 21.4% were in AF. AF prevalence was greater with increasing age (OR 1.04/year, p<0.001) in non-ischaemic cardiomyopathy (OR 2.34, p<0.001) and with increasing NYHA class (p<0.0001). Multiple logistic regression predictors of AF were age >70 years (OR 2.35), NYHA class II III or IV vs class I (OR 1.8, 4.4 and 3.1) and non-ischaemic cardiomyopathy (OR 3.2). A logistic model indicated that AF was associated with a 2.5 OR of being in NYHA class III-IV vs I-II while accounting for age, gender, left ventricular ejection fraction (LVEF), and aetiology of HF.


CONCLUSIONS
The prevalence of AF in HF patients exceeds 20%, and increases with age and functional class. The presence of AF leads to a more severe NYHA class, indicating that AF contributes to the severity of heart failure.
De Ferrari
Gaetano M
GM
Department of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
Klersy
Catherine
C
Ferrero
Paolo
P
Fantoni
Cecilia
C
Salerno-Uriarte
Diego
D
Manca
Lorenzo
L
Devecchi
Paolo
P
Molon
Giulio
G
Revera
Miriam
M
Curnis
Antonio
A
Sarzi Braga
Simona
S
Accardi
Francesco
F
Salerno-Uriarte
Jorge A
JA
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001281:Atrial Fibrillation / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications* / Q000503:physiopathology; D006801:Humans; D007558:Italy / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications / Q000503:physiopathology; D011237:Predictive Value of Tests; D015995:Prevalence; D012042:Registries; D012107:Research Design; D012720:Severity of Illness Index; D012737:Sex Factors; D013318:Stroke Volume