Atrial fibrillation in heart failure is associated with an increased risk of death only in patients with ischaemic heart disease.
OBJECTIVE
The prognostic importance of atrial fibrillation (AF) in heart failure (HF) populations is controversial and may depend on patient selection. In the present study, we investigated the prognostic impact of AF in a large population with HF of various aetiologies.


RESULTS
We included 2881 patients admitted to hospital with symptoms of worsening HF over a 4-year period (2001-2004), all patients were participants in the Echocardiography and Heart Outcome Study (ECHOS). Patients were followed for up to 7 years for all-cause mortality stratified according to heart rhythm (sinus rhythm, paroxysmal, or chronic AF) and according to the presence of ischaemic heart disease (IHD). During follow-up, 1934 patients (67%) died. In HF patients with a history of IHD, chronic AF was associated with an increased risk of death [hazard ratio (HR) 1.44; 95% confidence interval (CI): 1.18-1.77; P < 0.001). In contrast, in patients without IHD, chronic AF was not associated with an increased mortality risk (HR 0.88; 95% CI: 0.71-1.09; P = 0.25). There was significant interaction between the aetiology of HF and the prognostic importance of chronic AF (P(interaction) = 0.003).


CONCLUSIONS
In patients with HF, AF is associated with an increased risk of death only in patients with underlying IHD.
Raunsø
Jakob
J
Department of Cardiology, Gentofte Hospital, Copenhagen University Hospital, Post 67, Niels Andersens Vej 65, 2900 Hellerup, Denmark. jrj@heart.dk
Pedersen
Ole Dyg
OD
Dominguez
Helena
H
Hansen
Morten Lock
ML
Møller
Jacob Eifer
JE
Kjaergaard
Jesper
J
Hassager
Christian
C
Torp-Pedersen
Christian
C
Køber
Lars
L
D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000453:epidemiology* / Q000401:mortality; D002908:Chronic Disease; D003718:Denmark / Q000453:epidemiology; D018450:Disease Progression; D005260:Female; D006333:Heart Failure / Q000453:epidemiology* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017202:Myocardial Ischemia / Q000453:epidemiology*; D011379:Prognosis; D012307:Risk Factors; D016019:Survival Analysis