title: New-onset atrial fibrillation predicts heart failure progression.
abstract: BACKGROUND
  Atrial fibrillation and heart failure with reduced left ventricular ejection fraction have interrelated pathophysiologies. New-onset atrial fibrillation in heart failure patients has been associated with increased mortality, but has not been definitively related to clinical heart failure progression.
  
  
  METHODS
  To test the hypothesis that new-onset atrial fibrillation is related to clinical heart failure progression, in 2392 patients without atrial fibrillation at randomization in the Beta-blocker Evaluation of Survival Trial we measured clinical endpoints in patients who did (Group 1, n = 190) or did not (Group 2, n = 2202) develop new-onset atrial fibrillation. Results were also compared with the 303 patients who entered the trial in atrial fibrillation (Baseline/chronic group), and in Group 1/2 patients we conducted a multivariate analysis of covariates potentially related to time to first heart failure hospitalization.
  
  
  RESULTS
  Compared with Group 2, Group 1 patients post atrial fibrillation onset had a ∼2-fold increase in mortality (P < .0001) and a ∼4.5-fold increase in all-cause or heart failure hospitalization days/patient (hospitalization burden, both P < .0001). In Group 1, both types of hospitalization burden were 2.9-fold greater than in the Baseline/chronic group (P < .001), and hospitalization burden increased ∼6-fold (P < .0001) compared with the pre-event period. On multivariate analysis, new-onset atrial fibrillation was a highly significant (P < .00001) predictor of heart failure hospitalization.
  
  
  CONCLUSIONS
  In addition to being a discrete electrophysiologic event, in heart failure patients, new-onset atrial fibrillation is a predictor of and trigger for clinical heart failure progression.
authors.affiliation: Division of Cardiology, University of Colorado, Aurora. Electronic address: ryan.aleong@ucdenver.edu.
authors.forename: Ryan G
authors.initials: RG
authors.lastname: Aleong
authors.affiliation: Division of Cardiology, University of Colorado, Aurora.
authors.forename: William H
authors.initials: WH
authors.lastname: Sauer
authors.affiliation: ARCA biopharma, Inc., Westminster, Colo.
authors.forename: Gordon
authors.initials: G
authors.lastname: Davis
authors.affiliation: Division of Cardiology, University of Colorado, Aurora; ARCA biopharma, Inc., Westminster, Colo.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Bristow
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage / Q000627:therapeutic use; D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications* / Q000209:etiology; D018450:Disease Progression; D005260:Female; D006333:Heart Failure / Q000188:drug therapy / Q000209:etiology* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D011412:Propanolamines / Q000008:administration & dosage / Q000627:therapeutic use*; D016016:Proportional Hazards Models; D012307:Risk Factors; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000188:drug therapy
chemical_list: D000319:Adrenergic beta-Antagonists; D011412:Propanolamines; C024307:bucindolol
keywords: Atrial fibrillation; Beta-blockers; HFrEF; Heart failure markers