title: Atrial fibrillation in heart failure is associated with an increased risk of death only in patients with ischaemic heart disease.
abstract: 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.
authors.affiliation: Department of Cardiology, Gentofte Hospital, Copenhagen University Hospital, Post 67, Niels Andersens Vej 65, 2900 Hellerup, Denmark. jrj@heart.dk
authors.forename: Jakob
authors.initials: J
authors.lastname: Raunsø
authors.forename: Ole Dyg
authors.initials: OD
authors.lastname: Pedersen
authors.forename: Helena
authors.initials: H
authors.lastname: Dominguez
authors.forename: Morten Lock
authors.initials: ML
authors.lastname: Hansen
authors.forename: Jacob Eifer
authors.initials: JE
authors.lastname: Møller
authors.forename: Jesper
authors.initials: J
authors.lastname: Kjaergaard
authors.forename: Christian
authors.initials: C
authors.lastname: Hassager
authors.forename: Christian
authors.initials: C
authors.lastname: Torp-Pedersen
authors.forename: Lars
authors.initials: L
authors.lastname: Køber
mesh_terms: 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