Heart failure in patients with atrial fibrillation in Europe: a report from the EURObservational Research Programme Pilot survey on Atrial Fibrillation.
OBJECTIVE
The purpose of this study was too describe the associated baseline features of AF patients with heart failure (HF) with reduced and preserved ejection fraction (HFrEF and HFpEF). Secondly, we assessed symptomatic status and their clinical correlates. Finally, we examined independent predictors for 'heart failure' at the 1-year follow-up period.


RESULTS
A survey of European cardiologists from nine countries, participating in the EURObservational Research Programme Pilot survey on Atrial Fibrillation (EORP-AF Pilot), was carried out. Of the whole cohort of 2972 patients, 1411 (47.5%) had a diagnosis of HF. Of the AF patients with HF, oral anticoagulants were prescribed to 82.1% and antiarrhythmic drugs in 36.7%. Independent predictors of HFpEF were high body mass index, high heart rate, high systolic blood pressure, low diastolic blood pressure, high CHA2DS2-VASc score, and absence of chronic kidney disease, sleep apnoea, or ischaemic cardiomyopathy. On multivariate stepwise regression analysis, independent predictors of the development of HF were mode of AF presentation, diuretic use, prior HF, COPD, and valvular disease. At 1 year, HF was associated with a greater risk of all-cause mortality (log-rank test, P < 0.001). When HFrEF was compared with HFpEF at 1 year, crude rates were significant for the composite endpoint of 'stroke/thrombo-embolism/transient ischaemic attack and death' (15.9% vs. 11.1%, P = 0.043).


CONCLUSIONS
We provide insights into the clinical characteristics and outcomes in AF patients with HF, who were managed by European cardiologists. Despite a high prevalence of oral anticoagulant use, 1-year mortality and morbidity remained high in AF patients with HF, whether HFrEF or HFpEF. Such patients require a holistic approach to cardiovascular risk management.
University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK.|Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
Gregory Y H
GY
Lip
EURObservational Research Programme Department, European Society of Cardiology, Sophia Antipolis, France.
Cécile
C
Laroche
Cardiology Department, Faculty of Medicine Oradea, Emergency Clinical County Hospital of Oradea, Romania.
Mircea I
MI
Popescu
Department of Cardiology, Cardiovascular Research Centre, Aalborg University Hospital, Aalborg, Denmark.|Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Aalborg, Denmark.
Lars H
LH
Rasmussen
University of Trieste, Ospedale di Cattinara, AOU Ospedali Riuniti SC Cardiologia, Trieste, Italy.
Laura
L
Vitali-Serdoz
Colentina University Hospital, Department of Cardiology, Bucharest, Romania.
Gheorghe-Andrei
GA
Dan
Department of Cardiology, Silesian Center for Heart Disease, Zabrze, Poland.
Zbigniew
Z
Kalarus
Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands.
Harry J G M
HJ
Crijns
Cardiology Department, Santa Marta Hospital and Institute of Physiology, Faculty of Medicine, University of Lisbon, Lisbon, Portugal.
Mario M
MM
Oliveira
Maria Cecilia Hospital, GVM Care and Research, Ettore Sansavini Health Science Foundation, Cotignola, Italy.
Luigi
L
Tavazzi
EURObservational Research Programme Department, European Society of Cardiology, Sophia Antipolis, France.
Aldo P
AP
Maggioni
Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S. Orsola-Malpighi University Hospital, Bologna, Italy.
Giuseppe
G
Boriani
D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000188:drug therapy; D005060:Europe; D005260:Female; D006333:Heart Failure / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D012042:Registries; D013318:Stroke Volume / Q000502:physiology
D000925:Anticoagulants
Atrial fibrillation; Heart failure; Registry