A meta-analysis of the prognostic significance of atrial fibrillation in chronic heart failure.
OBJECTIVE
Atrial fibrillation (AF) is one of the commonest sustained arrhythmias in chronic heart failure (CHF), although the prognostic implications of the presence of AF in CHF remain controversial. We have therefore performed this meta-analysis to study the effects of the presence of AF on mortality in CHF patients.


RESULTS
A systematic MEDLINE search for all randomized trials and observational studies in which the influence of AF on CHF mortality was investigated and meta-analysis of the mortality data was performed. A total of 16 studies were identified of which 7 were randomized trials and 9 were observational studies including 30,248 and 23,721 patients, respectively. An adjusted meta-analysis of the data revealed that the presence of AF is associated with an adverse effect on total mortality with an odds ratio (OR) of 1.40 [95% confidence interval (CI) 1.32-1.48, P < 0.0001] in randomized trials and an OR of 1.14 (95% CI 1.03-1.26, P < 0.05) in observational studies. This increase in mortality associated with the presence of AF was observed in subgroups of CHF patients with both preserved and impaired left ventricular (LV) systolic function.


CONCLUSIONS
In conclusion, meta-analysis of 16 studies involving 53,969 patients suggests that the presence of AF is associated with an adverse prognosis in CHF irrespective of LV systolic function.
Mamas
Mamas A
MA
Department of Cardiology, Manchester University, Manchester, UK. mamasmamas1@yahoo.co.uk
Caldwell
Jane C
JC
Chacko
Sanoj
S
Garratt
Clifford J
CJ
Fath-Ordoubadi
Farzin
F
Neyses
Ludwig
L
D000368:Aged; D001281:Atrial Fibrillation / Q000401:mortality* / Q000503:physiopathology*; D016001:Confidence Intervals; D005260:Female; D006333:Heart Failure / Q000401:mortality*; D054143:Heart Failure, Systolic / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D006113:United Kingdom; D016277:Ventricular Function, Left