title: Prognostic role of atrial fibrillation in patients affected by chronic heart failure. Data from the MECKI score research group.
abstract: BACKGROUND
  Atrial fibrillation (AF) is common in heart failure (HF). It is unclear whether AF has an independent prognostic role in HF. The aim of the present study was to assess the prognostic role of AF in HF patients with reduced ejection fraction (EF).
  
  
  METHODS
  HF patients were followed in 17 centers for 3.15years (1.51-5.24). Study endpoints were the composite of cardiovascular (CV) death and heart transplant (HTX) and all-cause death. Data analysis was performed considering the entire population and a 1 to 1 match between sinus rhythm (SR) and AF patients. Match process was done for age±5, gender, left ventricle EF±5, peakVO2±3 (ml/min/kg) and recruiting center.
  
  
  RESULTS
  A total of 3447 patients (SR=2882, AF=565) were included in the study. Considering the entire population, CV death and HTX occurred in 114 (20%) AF vs. 471 (16%) SR (p=0.026) and all-cause death in 130 (23%) AF vs. 554 (19.2%) SR patients (p=0.039). At univariable Cox analysis, AF was significantly related to prognosis. Applying a multivariable model based on all variables significant at univariable analysis (EF, peakVO2, ventilation/carbon dioxide relationship slope, sodium, kidney function, hemoglobin, beta-blockers and digoxin) AF was no longer associated with adverse outcomes. Matching procedure resulted in 338 couples. CV death and HTX occurred in 63 (18.6%) AF vs. 74 (21.9%) SR (p=0.293) and all-cause death in 71 (21%) AF vs. 80 (23.6%) SR (p=0.406), with no survival differences between groups.
  
  
  CONCLUSIONS
  In systolic HF AF is a marker of disease severity but not an independent prognostic indicator.
authors.affiliation: Department of Advanced Biomedical Sciences, "Federico II" University, Napoli, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Paolillo
authors.affiliation: Centro Cardiologico Monzino, IRCCS, Milano, Italy; Department of Clinical Sciences and Community Health, Università di Milano, Milano, Italy. Electronic address: piergiuseppe.agostoni@unimi.it.
authors.forename: Piergiuseppe
authors.initials: P
authors.lastname: Agostoni
authors.affiliation: Cardiologia SUN, Ospedale Monaldi (Azienda dei Colli), Seconda Università di Napoli, Napoli, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Masarone
authors.affiliation: Divisione di Cardiologia Riabilitativa, Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Veruno, Veruno, Italy.
authors.forename: Ugo
authors.initials: U
authors.lastname: Corrà
authors.affiliation: Fondazione Gabriele Monasterio, CNR-Regione Toscana, Pisa, Italy; Scuola Superiore S. Anna, Pisa, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Passino
authors.affiliation: Division of Cardiology, "S. Maugeri" Foundation, IRCCS, Institute of Cassano Murge, Bari, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Scrutinio
authors.affiliation: Department of Cardiology, University of Foggia, Foggia, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Correale
authors.affiliation: Centro Cardiologico Monzino, IRCCS, Milano, Italy.
authors.forename: Gaia
authors.initials: G
authors.lastname: Cattadori
authors.affiliation: Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Metra
authors.affiliation: Dipartimento Cardiologico "A. De Gasperis", Ospedale Cà Granda-A.O. Niguarda, Milano, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Girola
authors.affiliation: UOC Cardiologia, G da Saliceto Hospital, Piacenza, Italy.
authors.forename: Massimo F
authors.initials: MF
authors.lastname: Piepoli
authors.affiliation: Centro Cardiologico Monzino, IRCCS, Milano, Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Salvioni
authors.affiliation: Centro Cardiologico Monzino, IRCCS, Milano, Italy.
authors.forename: Marta
authors.initials: M
authors.lastname: Giovannardi
authors.affiliation: Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy.
authors.forename: Annamaria
authors.initials: A
authors.lastname: Iorio
authors.affiliation: Fondazione Gabriele Monasterio, CNR-Regione Toscana, Pisa, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Emdin
authors.affiliation: Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Tradate, Dipartimento di Medicina e Riabilitazione Cardiorespiratoria Unità Operativa di Cardiologia Riabilitativa, Tradate, Varese, Italy.
authors.forename: Rosa
authors.initials: R
authors.lastname: Raimondo
authors.affiliation: Cardiology Division, Cardiac Arrhythmia Center and Cardiomyopathies Unit, San Camillo-Forlanini Hospital, Roma, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Re
authors.affiliation: Section of Cardiology, Department of Medicine, University of Verona, Italy.
authors.forename: Mariantonietta
authors.initials: M
authors.lastname: Cicoira
authors.affiliation: Cardiologia Riabilitativa, Azienda Ospedali Riuniti, Ancona, Italy.
authors.forename: Romualdo
authors.initials: R
authors.lastname: Belardinelli
authors.affiliation: Heart Failure Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Guazzi
authors.affiliation: Heart Failure Unit, ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Clemenza
authors.affiliation: Department of Health Science, University of Milano Bicocca & Department of Cardiology, San Luca Hospital, Istituto Auxologico Italiano, Milano, Italy.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Parati
authors.affiliation: Cardiology Division, Santo Spirito Hospital, Roma, Italy.
authors.forename: Angela B
authors.initials: AB
authors.lastname: Scardovi
authors.affiliation: Centro Cardiovascolare, Azienda per i Servizi Sanitari no. 1, Trieste, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Di Lenarda
authors.affiliation: Division of Cardiology, "S. Maugeri" Foundation, IRCCS, Institute of Cassano Murge, Bari, Italy.
authors.forename: Rocco
authors.initials: R
authors.lastname: La Gioia
authors.affiliation: Dipartimento Cardiologico "A. De Gasperis", Ospedale Cà Granda-A.O. Niguarda, Milano, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Frigerio
authors.affiliation: Department of Cardiology, University of Foggia, Foggia, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Lombardi
authors.affiliation: SDN Foundation, Institute of Diagnostic and Nuclear Development, Napoli, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Gargiulo
authors.affiliation: Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Sinagra
authors.affiliation: Cardiologia SUN, Ospedale Monaldi (Azienda dei Colli), Seconda Università di Napoli, Napoli, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Pacileo
authors.affiliation: Department of Advanced Biomedical Sciences, "Federico II" University, Napoli, Italy.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Perrone-Filardi
authors.affiliation: Cardiologia SUN, Ospedale Monaldi (Azienda dei Colli), Seconda Università di Napoli, Napoli, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Limongelli
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000453:epidemiology*; D015415:Biomarkers; D002908:Chronic Disease; D005260:Female; D006333:Heart Failure / Q000150:complications*; D006760:Hospitalization; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D012044:Regression Analysis; D012720:Severity of Illness Index; D016277:Ventricular Function, Left / Q000502:physiology*
chemical_list: D015415:Biomarkers
keywords: Atrial fibrillation; Heart failure; MECKI score; Matching analysis; Prognosis