title: No impact of atrial fibrillation on mortality risk in optimally treated heart failure patients.
abstract: BACKGROUND
  Several studies have shown that atrial fibrillation (AF) is associated with increased risk of death in heart failure (HF) patients. However, it is not clear whether this increased risk is independent of other risk factors.
  
  
  OBJECTIVE
  We hypothesized that AF would be an independent risk factor for death in a large cohort of HF patients.
  
  
  METHODS
  Patients referred to Norwegian HF outpatient clinics were enrolled between October 2000 and February 2008. Patients with heart rhythm other than AF or sinus rhythm were excluded. Mortality data were obtained from the National Statistics Bureau, Statistics Norway with the last update February 2008.
  
  
  RESULTS
  There were 4048 patients included in the analysis, with a median follow-up of 28 months. Adherence to guidelines regarding medical treatment was high. In univariate analysis, AF patients (n = 1391) had a higher risk of death than patients in sinus rhythm (n = 2657) (hazard ratio [HR] 1.181; 95% confidence interval (CI), 1.044-1.336; P = 0.008). However, after adjusting for confounding factors (age, New York Heart Association class, coronary artery disease as the main cause of HF, use of any loop diuretic, hemoglobin level, and serum creatinine), AF was no longer associated with increased risk of death (HR 1.037; 95% CI, 0.901-1.193; P = 0.619).
  
  
  CONCLUSIONS
  In this cohort of heart failure patients receiving optimal medical treatment at specialized HF clinics, AF was not associated with increased risk of death after adjusting for confounding factors.
authors.affiliation: Department of Internal Medicine Baerum Hospital, Vestre Viken Hospital Trust, Rud, Norway. arnljot.tveit@vestreviken.no
authors.forename: Arnljot
authors.initials: A
authors.lastname: Tveit
authors.forename: Berit
authors.initials: B
authors.lastname: Flonaes
authors.forename: Ellinor
authors.initials: E
authors.lastname: Aaser
authors.forename: Kari
authors.initials: K
authors.lastname: Korneliussen
authors.forename: Gisle
authors.initials: G
authors.lastname: Froland
authors.forename: Lars
authors.initials: L
authors.lastname: Gullestad
authors.forename: Morten
authors.initials: M
authors.lastname: Grundtvig
mesh_terms: D000367:Age Factors; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology; D015331:Cohort Studies; D003324:Coronary Artery Disease; D005260:Female; D006305:Health Status Indicators; D006333:Heart Failure / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D009664:Norway; D010045:Outpatients; D018570:Risk Assessment / Q000379:methods
chemical_list: D000959:Antihypertensive Agents