title: Impact of atrial fibrillation and heart failure, independent of each other and in combination, on mortality in community-dwelling older adults.
abstract: Atrial fibrillation (AF) and heart failure (HF), common in older adults, are associated with poor outcomes. However, little is known about their impact, independent of each other. We studied 5,673 community-dwelling adults aged ≥ 65 years in the Cardiovascular Health Study. Baseline prevalent AF and HF were centrally adjudicated, and 116 patients had AF only, 219 had HF only, 39 had both, and 5,263 had neither. The Cox proportional hazards model was used to estimate age-gender-race-adjusted hazard ratio (aHR) and 95% confidence intervals (CIs) for all-cause, cardiovascular (CV), and non-CV mortalities. Participants had a mean age of 73 years (± 6 years), 58% were women, and 15% African-American. During 13 years of follow-up, all-cause mortality occurred in 43%, 66%, 74%, and 85% of those with neither, AF only, HF only, and both, respectively. Compared with neither, aHR (95% CIs) for all-cause mortality associated with AF only, HF only, and both was 1.36 (1.08 to 1.72), 2.31 (1.97 to 2.71), and 3.04 (2.15 to 4.29), respectively. Similar associations were observed with CV mortality, but HF only also had greater non-CV mortality (aHR 1.72, 95% CI 1.35 to 2.18). Compared with AF alone, aHR (95% CIs) associated with HF alone for all-cause, CV, and non-CV mortalities was 1.69 (1.29 to 2.23), 1.73 (1.20 to 2.51), and 1.64 (1.09 to 2.46), respectively. Compared with HF alone, those with both conditions had greater CV but not all-cause mortality. In conclusion, community-dwelling older adults with AF have greater mortality than those without but lesser than those with HF, and both conditions were associated with greater CV and all-cause mortalities, whereas only those with HF had greater non-CV mortality.
authors.affiliation: University of Alabama at Birmingham, Birmingham, Alabama; Veterans Affairs Medical Center, Birmingham, Alabama. Electronic address: nbajaj@uabmc.edu.
authors.forename: Navkaranbir S
authors.initials: NS
authors.lastname: Bajaj
authors.affiliation: University of Alabama at Birmingham, Birmingham, Alabama; Veterans Affairs Medical Center, Birmingham, Alabama.
authors.forename: Vikas
authors.initials: V
authors.lastname: Bhatia
authors.affiliation: University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Kumar
authors.initials: K
authors.lastname: Sanam
authors.affiliation: University of Alabama at Birmingham, Birmingham, Alabama; Veterans Affairs Medical Center, Birmingham, Alabama.
authors.forename: Sameer
authors.initials: S
authors.lastname: Ather
authors.affiliation: University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Taimoor
authors.initials: T
authors.lastname: Hashim
authors.affiliation: University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Charity
authors.initials: C
authors.lastname: Morgan
authors.affiliation: University of California, Los Angeles, Los Angeles, California.
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.affiliation: University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Navin C
authors.initials: NC
authors.lastname: Nanda
authors.affiliation: University of Alabama at Birmingham, Birmingham, Alabama; Veterans Affairs Medical Center, Birmingham, Alabama.
authors.forename: Sumanth D
authors.initials: SD
authors.lastname: Prabhu
authors.affiliation: Papanikolaou Hospital, Thessaloniki, Greece.
authors.forename: Chris
authors.initials: C
authors.lastname: Adamopoulos
authors.affiliation: Veterans Affairs Medical Center, Washington, DC.
authors.forename: Raya
authors.initials: R
authors.lastname: Kheirbek
authors.affiliation: New York Medical College, Valhalla, New York.
authors.forename: Wilbert S
authors.initials: WS
authors.lastname: Aronow
authors.affiliation: Veterans Affairs Medical Center, Washington, DC.
authors.forename: Ross D
authors.initials: RD
authors.lastname: Fletcher
authors.affiliation: Department of Innovative Clinical Trials, University Medical Centre Göttingen, Göttingen, Germany.
authors.forename: Stefan D
authors.initials: SD
authors.lastname: Anker
authors.affiliation: University of Alabama at Birmingham, Birmingham, Alabama; Veterans Affairs Medical Center, Birmingham, Alabama.
authors.forename: Ali
authors.initials: A
authors.lastname: Ahmed
authors.affiliation: University of California, San Francisco, Fresno, California.
authors.forename: Prakash
authors.initials: P
authors.lastname: Deedwania
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000401:mortality*; D002423:Cause of Death / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000401:mortality*; D006801:Humans; D008297:Male; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology