title: Temporal relationship and prognostic significance of atrial fibrillation in heart failure patients with preserved ejection fraction: a community-based study.
abstract: BACKGROUND
  In patients with heart failure and preserved ejection fraction (HFpEF), atrial fibrillation (AF) may predate, concur with, or develop after HFpEF diagnosis. We sought to define the temporal relationship between AF and HFpEF, to identify factors associated with AF, and to determine the prognostic impact of prevalent and incident AF in HFpEF.
  
  
  RESULTS
  From 1983 to 2010, 939 Olmsted County, Minnesota, residents (age, 77±12 years; 61% female) newly diagnosed with HFpEF (EF ≥0.50) were evaluated. Baseline rhythm classification included prior AF (>3 months before HFpEF diagnosis), concurrent AF (±3 months), or sinus rhythm. Incident AF (>3 months after HFpEF diagnosis) and all-cause mortality were ascertained through February 2012. Prior AF (29%) and concurrent AF (23%) were associated with older age, higher brain-type natriuretic peptide, and larger left atrial volume index at HFpEF diagnosis compared with sinus rhythm. Of HFpEF patients in sinus rhythm at diagnosis, 32% developed AF over a median follow-up of 3.7 years (interquartile range, 1.5-6.7 years; 69 events per 1000 person-years). Age and diastolic dysfunction were positively and statin use was inversely associated with incident AF. With no AF used as the referent, prior or concurrent AF (combined hazard ratio, 1.3; 95% confidence interval, 1.0-1.6; P=0.03) and incident AF, modeled as a time-dependent covariate (hazard ratio, 2.1; 95% confidence interval, 1.4-3.0; P<0.001), were independently associated with death after adjustment for pertinent covariates.
  
  
  CONCLUSIONS
  AF occurs in two thirds of HFpEF patients at some point in the natural history and confers a poor prognosis. Further study is required to determine whether intervention for AF may improve outcomes or if statin use can prevent AF in HFpEF.
authors.affiliation: Cardiorenal Research Laboratory and Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. zakeri.rosita@mayo.edu
authors.forename: Rosita
authors.initials: R
authors.lastname: Zakeri
authors.forename: Alanna M
authors.initials: AM
authors.lastname: Chamberlain
authors.forename: Véronique L
authors.initials: VL
authors.lastname: Roger
authors.forename: Margaret M
authors.initials: MM
authors.lastname: Redfield
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D008297:Male; D011379:Prognosis; D012111:Residence Characteristics; D013318:Stroke Volume / Q000502:physiology*; D015996:Survival Rate / Q000639:trends; D013997:Time Factors
keywords: atrial fibrillation; heart failure, diastolic; population; prognosis
references.citation: Atherosclerosis. 2004 Mar;173(1):1-12
references.pmid: 15177118
references.citation: Eur J Heart Fail. 2008 Jun;10(6):566-72
references.pmid: 18456551
references.citation: N Engl J Med. 2007 Nov 29;357(22):2248-61
references.pmid: 17984166
references.citation: Mayo Clin Proc. 1996 Mar;71(3):266-74
references.pmid: 8594285
references.citation: Am Heart J. 2005 Mar;149(3):489-96
references.pmid: 15864238
references.citation: Am J Cardiol. 2003 Dec 15;92(12):1379-83
references.pmid: 14675569
references.citation: Circulation. 2011 May 17;123(19):2094-100
references.pmid: 21536994
references.citation: Lancet. 2009 Feb 28;373(9665):739-45
references.pmid: 19249635
references.citation: JAMA. 2006 Nov 8;296(18):2209-16
references.pmid: 17090767
references.citation: N Engl J Med. 2008 Jun 19;358(25):2667-77
references.pmid: 18565859
references.citation: Circulation. 1998 Nov 24;98(21):2282-9
references.pmid: 9826315
references.citation: Eur J Heart Fail. 2009 Jul;11(7):676-83
references.pmid: 19553398
references.citation: J Am Coll Cardiol. 2004 Feb 4;43(3):429-35
references.pmid: 15013126
references.citation: J Am Coll Cardiol. 1998 Sep;32(3):695-703
references.pmid: 9741514
references.citation: J Am Coll Cardiol. 2003 Jan 15;41(2):217-23
references.pmid: 12535812
references.citation: J Am Coll Cardiol. 2006 May 16;47(10):1997-2004
references.pmid: 16697316
references.citation: Eur Heart J. 2008 Jul;29(13):1618-24
references.pmid: 18515809
references.citation: J Am Coll Cardiol. 2008 Feb 26;51(8):828-35
references.pmid: 18294568
references.citation: Circ Cardiovasc Qual Outcomes. 2012 Jan;5(1):85-93
references.pmid: 22235070
references.citation: Circ Heart Fail. 2011 Jan;4(1):27-35
references.pmid: 21068341
references.citation: Circ Heart Fail. 2011 Nov;4(6):740-6
references.pmid: 21920917
references.citation: Circulation. 2009 May 12;119(18):2516-25
references.pmid: 19433768
references.citation: Am J Cardiol. 2004 Jan 1;93(1):54-8
references.pmid: 14697466
references.citation: J Am Heart Assoc. 2013 Feb 01;2(1):e005694
references.pmid: 23525446
references.citation: Ann Intern Med. 2002 Oct 15;137(8):631-9
references.pmid: 12379062
references.citation: Eur Heart J. 2009 Oct;30(19):2327-36
references.pmid: 19717850
references.citation: N Engl J Med. 1997 Nov 6;337(19):1360-9
references.pmid: 9358131
references.citation: Circulation. 2006 Jul 11;114(2):119-25
references.pmid: 16818816
references.citation: JAMA. 2004 Jul 21;292(3):344-50
references.pmid: 15265849
references.citation: Eur J Heart Fail. 2011 Oct;13(10):1111-20
references.pmid: 21642293
references.citation: Circulation. 2003 Jun 17;107(23):2920-5
references.pmid: 12771006
references.citation: Eur J Heart Fail. 2008 Feb;10(2):149-56
references.pmid: 18279770
references.citation: J Am Coll Cardiol. 2009 Sep 29;54(14):1280-9
references.pmid: 19778670
references.citation: Am J Cardiol. 2003 Mar 20;91(6A):2D-8D
references.pmid: 12670636
references.citation: Am J Cardiol. 2006 Apr 15;97(8):1266
references.pmid: 16616039
references.citation: J Am Coll Cardiol. 2002 Nov 6;40(9):1636-44
references.pmid: 12427417
references.citation: Eur J Heart Fail. 2004 Jun;6(4):421-6
references.pmid: 15182766
references.citation: Circulation. 2006 Oct 3;114(14):1455-61
references.pmid: 17000910
references.citation: Am Heart J. 2006 Jul;152(1):86-92
references.pmid: 16838426
references.citation: Eur Heart J. 2004 Jul;25(14):1214-20
references.pmid: 15246639
references.citation: J Am Coll Cardiol. 1999 Jun;33(7):1948-55
references.pmid: 10362198
references.citation: N Engl J Med. 2002 Dec 5;347(23):1825-33
references.pmid: 12466506
references.citation: Heart. 2009 May;95(9):704-8
references.pmid: 19176561
references.citation: Am Heart J. 2009 Jul;158(1):111-7
references.pmid: 19540400
references.citation: JAMA. 2001 Jun 13;285(22):2864-70
references.pmid: 11401607
references.citation: Circulation. 2002 Sep 17;106(12):1447-52
references.pmid: 12234946