title: QRS duration predicts death and hospitalization among patients with atrial fibrillation irrespective of heart failure: evidence from the AFFIRM study.
abstract: OBJECTIVE
  The association of QRS duration (QRSd) with morbidity and mortality is understudied in patients with atrial fibrillation (AF). We sought to assess any association of prolonged QRS with increased risk of death or hospitalization among patients with AF.
  
  
  RESULTS
  QRS duration was retrieved from the baseline electrocardiograms of patients enroled in the Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) study and divided into three categories: <90, 90-119, ≥120 ms. Cox models were applied relating the hazards of mortality and hospitalizations to QRSd. Among 3804 patients with AF, 593 died and 2305 were hospitalized. Compared with those with QRS < 90 ms, patients with QRS ≥ 120 ms, had an increased mortality [hazard ratio (HR) 1.61, 95% confidence interval (CI): 1.29-2.03, P < 0.001] and hospitalizations (HR 1.14, 95% CI: 1.07-1.34, P = 0.043) over an average follow-up of 3.5 years. Importantly, for patients with QRS 90-119 ms, mortality and hospitalization were also increased (HR 1.31, P = 0.005 and 1.11, P = 0.026, respectively). In subgroup analysis based on heart failure (HF) status (previously documented or ejection fraction <40%), mortality was increased for QRS ≥ 120 ms patients with (HR 1.87, P < 0.001) and without HF (HR 1.63, P = 0.02). In the QRS 90-119 ms group, mortality was increased (HR 1.38, P = 0.03) for those with HF, but not significantly among those without HF (HR 1.23, P = 0.14).
  
  
  CONCLUSIONS
  Among patients with AF, QRSd ≥ 120 ms was associated with a substantially increased risk for mortality (all-cause, cardiovascular, and arrhythmic) and hospitalization. Interestingly, an increased mortality was also observed among those with QRS 90-119 ms and concomitant HF.
authors.affiliation: Essentia Heart and Vascular, Department of Cardiology, Fargo, ND 58103, USA.
authors.forename: Matthew G
authors.initials: MG
authors.lastname: Whitbeck
authors.affiliation: Division of Cardiovascular Medicine, Gill Heart Institute University of Kentucky, 326 C.T. Wethington Building, 900 South Limestone Street, Lexington, KY 40536-0200, USA.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Charnigo
authors.affiliation: Division of Cardiovascular Medicine, Gill Heart Institute University of Kentucky, 326 C.T. Wethington Building, 900 South Limestone Street, Lexington, KY 40536-0200, USA.
authors.forename: Jignesh
authors.initials: J
authors.lastname: Shah
authors.affiliation: Division of Cardiovascular Medicine, Gill Heart Institute University of Kentucky, 326 C.T. Wethington Building, 900 South Limestone Street, Lexington, KY 40536-0200, USA.
authors.forename: Gustavo
authors.initials: G
authors.lastname: Morales
authors.affiliation: Division of Cardiovascular Medicine, Gill Heart Institute University of Kentucky, 326 C.T. Wethington Building, 900 South Limestone Street, Lexington, KY 40536-0200, USA.
authors.forename: Steve W
authors.initials: SW
authors.lastname: Leung
authors.affiliation: Division of Cardiovascular Medicine, Gill Heart Institute University of Kentucky, 326 C.T. Wethington Building, 900 South Limestone Street, Lexington, KY 40536-0200, USA.
authors.forename: Brandon
authors.initials: B
authors.lastname: Fornwalt
authors.affiliation: Division of Cardiovascular Medicine, Gill Heart Institute University of Kentucky, 326 C.T. Wethington Building, 900 South Limestone Street, Lexington, KY 40536-0200, USA.
authors.forename: Alison L
authors.initials: AL
authors.lastname: Bailey
authors.affiliation: Division of Cardiovascular Medicine, Gill Heart Institute University of Kentucky, 326 C.T. Wethington Building, 900 South Limestone Street, Lexington, KY 40536-0200, USA.
authors.forename: Khaled
authors.initials: K
authors.lastname: Ziada
authors.affiliation: Division of Cardiovascular Medicine, Gill Heart Institute University of Kentucky, 326 C.T. Wethington Building, 900 South Limestone Street, Lexington, KY 40536-0200, USA.
authors.forename: Vincent L
authors.initials: VL
authors.lastname: Sorrell
authors.affiliation: Department of Veterans Affairs, North Dakota State University, Fargo, ND 58102, USA.
authors.forename: Milagros M
authors.initials: MM
authors.lastname: Zegarra
authors.affiliation: Division of Cardiovascular Medicine, Gill Heart Institute University of Kentucky, 326 C.T. Wethington Building, 900 South Limestone Street, Lexington, KY 40536-0200, USA.
authors.forename: Jenks
authors.initials: J
authors.lastname: Thompson
authors.affiliation: Division of Cardiovascular Medicine, Gill Heart Institute University of Kentucky, 326 C.T. Wethington Building, 900 South Limestone Street, Lexington, KY 40536-0200, USA.
authors.forename: Neil Aboul
authors.initials: NA
authors.lastname: Hosn
authors.affiliation: Division of Cardiovascular Medicine, Gill Heart Institute University of Kentucky, 326 C.T. Wethington Building, 900 South Limestone Street, Lexington, KY 40536-0200, USA.
authors.forename: Charles L
authors.initials: CL
authors.lastname: Campbell
authors.affiliation: Division of Cardiovascular Medicine, Gill Heart Institute University of Kentucky, 326 C.T. Wethington Building, 900 South Limestone Street, Lexington, KY 40536-0200, USA.
authors.forename: John
authors.initials: J
authors.lastname: Gurley
authors.affiliation: Division of Cardiovascular Medicine, Gill Heart Institute University of Kentucky, 326 C.T. Wethington Building, 900 South Limestone Street, Lexington, KY 40536-0200, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Anaya
authors.affiliation: Division of Cardiovascular Medicine, Gill Heart Institute University of Kentucky, 326 C.T. Wethington Building, 900 South Limestone Street, Lexington, KY 40536-0200, USA.
authors.forename: David C
authors.initials: DC
authors.lastname: Booth
authors.affiliation: Texas Cardiac Arrhythmia Institute, Department of Cardiology, Austin, TX 78746, USA.
authors.forename: Luigi
authors.initials: L
authors.lastname: Di Biase
authors.affiliation: Texas Cardiac Arrhythmia Institute, Department of Cardiology, Austin, TX 78746, USA.
authors.forename: Andrea
authors.initials: A
authors.lastname: Natale
authors.affiliation: Division of Cardiovascular Medicine, Gill Heart Institute University of Kentucky, 326 C.T. Wethington Building, 900 South Limestone Street, Lexington, KY 40536-0200, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Smyth
authors.affiliation: Division of Cardiovascular Medicine, Gill Heart Institute University of Kentucky, 326 C.T. Wethington Building, 900 South Limestone Street, Lexington, KY 40536-0200, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Moliterno
authors.affiliation: Division of Cardiovascular Medicine, Gill Heart Institute University of Kentucky, 326 C.T. Wethington Building, 900 South Limestone Street, Lexington, KY 40536-0200, USA samy-claude.elayi@uky.edu.
authors.forename: Claude S
authors.initials: CS
authors.lastname: Elayi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000401:mortality* / Q000517:prevention & control*; D015984:Causality; D015897:Comorbidity; D004562:Electrocardiography / Q000379:methods / Q000706:statistics & numerical data*; D019317:Evidence-Based Medicine; D005260:Female; D006333:Heart Failure / Q000401:mortality* / Q000517:prevention & control*; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007629:Kentucky / Q000453:epidemiology; D008297:Male; D015995:Prevalence; D011379:Prognosis; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods / Q000706:statistics & numerical data; D012680:Sensitivity and Specificity; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Arrhythmia; Atrial fibrillation; Bundle branch block; Heart failure; QRS duration