title: Atrial fibrillation and mortality in heart failure: a community study.
abstract: BACKGROUND
  Heart failure (HF) and atrial fibrillation (AF) share common risk factors and often coexist. The combination of HF and AF may carry a worse prognosis than either condition alone; however, the magnitude of this risk remains controversial and it is not known whether the timing of AF influences the risk of death.
  
  
  RESULTS
  We determined the risk of all-cause mortality in relation to the presence of AF prior to or after HF diagnosis in a community-based cohort of persons diagnosed as having HF between 1983 and 2006. Of 1664 individuals with HF, 553 had a history of AF and 384 developed AF after HF. During a median follow-up of 4.0 years, 450 deaths occurred among persons with prior AF, 314 among those with AF after HF, and 572 among patients without AF. In fully adjusted models, compared with patients without AF, those with AF prior to HF had a 29% increased risk of death, whereas those who developed AF after HF exhibited >2-fold increased risk of death.
  
  
  CONCLUSIONS
  In the community, AF is frequent in the setting of HF and is associated with a large excess risk of death. The magnitude of this excess risk differs markedly according to the timing of AF, with AF developing after HF conferring the largest increased risk of death compared with HF patients without AF.
authors.affiliation: Department of Health Sciences Research, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55095, USA.
authors.forename: Alanna M
authors.initials: AM
authors.lastname: Chamberlain
authors.forename: Margaret M
authors.initials: MM
authors.lastname: Redfield
authors.forename: Alvaro
authors.initials: A
authors.lastname: Alonso
authors.forename: Susan A
authors.initials: SA
authors.lastname: Weston
authors.forename: Véronique L
authors.initials: VL
authors.lastname: Roger
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000453:epidemiology*; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors