title: Atrial fibrillation and outcomes in heart failure with preserved versus reduced left ventricular ejection fraction.
abstract: BACKGROUND
  Atrial fibrillation (AF) and heart failure (HF) are 2 of the most common cardiovascular conditions nationally and AF frequently complicates HF. We examined how AF has impacts on adverse outcomes in HF-PEF versus HF-REF within a large, contemporary cohort.
  
  
  RESULTS
  We identified all adults diagnosed with HF-PEF or HF-REF based on hospital discharge and ambulatory visit diagnoses and relevant imaging results for 2005-2008 from 4 health plans in the Cardiovascular Research Network. Data on demographic features, diagnoses, procedures, outpatient pharmacy use, and laboratory results were ascertained from health plan databases. Hospitalizations for HF, stroke, and any reason were identified from hospital discharge and billing claims databases. Deaths were ascertained from health plan and state death files. Among 23 644 patients with HF, 11 429 (48.3%) had documented AF (9081 preexisting, 2348 incident). Compared with patients who did not have AF, patients with AF had higher adjusted rates of ischemic stroke (hazard ratio [HR] 2.47 for incident AF; HR 1.57 for preexisting AF), hospitalization for HF (HR 2.00 for incident AF; HR 1.22 for preexisting AF), all-cause hospitalization (HR 1.45 for incident AF; HR 1.15 for preexisting AF), and death (incident AF HR 1.67; preexisting AF HR 1.13). The associations of AF with these outcomes were similar for HF-PEF and HF-REF, with the exception of ischemic stroke.
  
  
  CONCLUSIONS
  AF is a potent risk factor for adverse outcomes in patients with HF-PEF or HF-REF. Effective interventions are needed to improve the prognosis of these high-risk patients.
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical Center, Worcester, MA 01655, USA. mcmanusd@ummhc.org
authors.forename: David D
authors.initials: DD
authors.lastname: McManus
authors.forename: Grace
authors.initials: G
authors.lastname: Hsu
authors.forename: Sue Hee
authors.initials: SH
authors.lastname: Sung
authors.forename: Jane S
authors.initials: JS
authors.lastname: Saczynski
authors.forename: David H
authors.initials: DH
authors.lastname: Smith
authors.forename: David J
authors.initials: DJ
authors.lastname: Magid
authors.forename: Jerry H
authors.initials: JH
authors.lastname: Gurwitz
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Goldberg
authors.forename: Alan S
authors.initials: AS
authors.lastname: Go
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D002545:Brain Ischemia / Q000453:epidemiology; D016009:Chi-Square Distribution; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology; D013318:Stroke Volume; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D016277:Ventricular Function, Left