title: The intersection of atrial fibrillation and heart failure in a hospitalised population.
abstract: OBJECTIVE
  This work set out to comprehensively characterize patients admitted to hospital with both atrial fibrillation (AF) and heart failure (HF) and to compare this cohort of patients to the global hospital population of patients with only one of these diagnoses.
  
  
  RESULTS
  This was a retrospective analysis of all in-patients with HF and AF admitted to a large urban hospital over a 3-month period. Patients with AF were identified by both discharge codes and electrocardiograms. HF patients were identified by means of discharge codes for HF and by screening all patients with AF, a common comorbidity of HF. Evidence for left ventricular (LV) dysfunction was sought. Of patients with AF (n = 453), 43% had symptoms of HF and LV dysfunction. Of patients with a discharge code and confirmed HF (n = 286), 34% had AF, 60% of whom were in chronic AF. Compared to HF patients in sinus rhythm those in AF were older (70 +/- 10 y vs 67 +/- 12 y, P < 0.02), had a higher prevalence of valvular heart disease (25% vs 7%, P < 0.0001) and a lower prevalence of ischaemic heart disease (17% vs 40%, P < 0.0001). HF patients identified by discharge codes in AF were more likely to have QRS > or = 120 msec (18% vs 12% in sinus rhythm; P= ns). Patients with AF and deemed to suffer concomitant HF, as opposed to AF alone, were significantly more likely to have QRS prolongation (QRS > or = 120 msec 27% vs 8%, P < 0.05). 8% of patients with AF and HF had a QRS > 150 msec.
  
  
  CONCLUSIONS
  AF and HF are frequent, concomitant pathologies in a hospitalised population. AF complicates HF assessment and treatment. Greater dyssynchrony, as denoted by ECG, in the AF and HF population suggests opportunities for treatment of HF by cardiac resynchronization therapy and ablative therapies.
authors.affiliation: Aintree Cardiac Centre, Aintree University Hospital, Liverpool.
authors.forename: Julia D
authors.initials: JD
authors.lastname: Jones
authors.forename: Aleem U
authors.initials: AU
authors.lastname: Khand
authors.forename: Homeyra
authors.initials: H
authors.lastname: Douglas
authors.forename: Reza
authors.initials: R
authors.lastname: Ashrafi
authors.forename: Morag
authors.initials: M
authors.lastname: Shaw
authors.forename: John G F
authors.initials: JG
authors.lastname: Cleland
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D015897:Comorbidity; D004562:Electrocardiography; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D006349:Heart Valve Diseases / Q000150:complications* / Q000453:epidemiology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications* / Q000453:epidemiology; D018579:Patient Selection; D015995:Prevalence; D012189:Retrospective Studies; D063189:Symptom Assessment; D006113:United Kingdom / Q000453:epidemiology; D018487:Ventricular Dysfunction, Left / Q000453:epidemiology / Q000503:physiopathology