title: The prognostic significance of atrial fibrillation in heart failure with preserved ejection function: insights from KaRen, a prospective and multicenter study.
abstract: The prognostic value of atrial fibrillation (AF) in heart failure with preserved ejection fraction (HFPEF) remains controversial. We sought to study the prognostic value of AF in a prospective cohort and to characterize the HFPEF patients with AF. KaRen was a prospective, multicenter, international, observational study intended to characterize HFPEF; 538 patients presenting with an acute decompensated cardiac failure and a left ventricular EF > 45% were included. EKG and echocardiogram performed 4-8 week following the index hospitalization were analyzed in core centers. Clinical and echocardiographic characteristics of patients in sinus rhythm vs. with documented AF at enrolment (decompensated HF), upon their 4-8-week visit (in presumed stable clinical condition) and according to patients' cardiac history, were compared. The primary study endpoint was death from any cause or first hospitalization for decompensated heart failure (HF). A total of 413 patients (32% in AF) were analyzed, with a mean follow-up period of 28 months. The patients were primarily elderly individuals (mean age: 76.2 years), with a slight female predominance and a high prevalence of non-cardiovascular comorbidities. The baseline echocardiographic characteristics and the natriuretic peptide levels were indicative of a more severe heart condition among the patients with AF. However, the patients with AF exhibited a similar survival-free interval compared with the patients in sinus rhythm. In this elderly HFPEF population with a high prevalence of non-cardiovascular comorbidities, the presence of AF was not associated with a worse prognosis despite impaired clinical and echocardiographic features.ClinicalTrials.gov: NCT00774709.
authors.affiliation: Cardiology Department and CIC-IT U 804, Hôpital Pontchaillou, Rennes University Health Center, Rue Henri Le Guillou, 35000, Rennes, France. christian.bosseau@chu-rennes.fr.|LTSI, Rennes 1 University, INSERM 1099, Rennes, France. christian.bosseau@chu-rennes.fr.
authors.forename: Christian
authors.identifier: http://orcid.org/0000-0001-8245-9218
authors.initials: C
authors.lastname: Bosseau
authors.affiliation: Cardiology Department and CIC-IT U 804, Hôpital Pontchaillou, Rennes University Health Center, Rue Henri Le Guillou, 35000, Rennes, France.|LTSI, Rennes 1 University, INSERM 1099, Rennes, France.
authors.forename: Erwan
authors.initials: E
authors.lastname: Donal
authors.affiliation: Department of Medicine, Karolinska Institutet and Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Lars H
authors.initials: LH
authors.lastname: Lund
authors.affiliation: Clinical Investigation Center INSERM CIC-1414, CHU Rennes, Rennes, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Oger
authors.affiliation: Department of Medicine, Karolinska Institutet and Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Camilla
authors.initials: C
authors.lastname: Hage
authors.affiliation: French Society of Cardiology, Paris, France.
authors.forename: Geneviève
authors.initials: G
authors.lastname: Mulak
authors.affiliation: Cardiology Department and CIC-IT U 804, Hôpital Pontchaillou, Rennes University Health Center, Rue Henri Le Guillou, 35000, Rennes, France.|LTSI, Rennes 1 University, INSERM 1099, Rennes, France.
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Daubert
authors.affiliation: Department of Medicine, Karolinska Institutet and Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Linde
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000401:mortality* / Q000503:physiopathology*; D015897:Comorbidity; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D005602:France; D006333:Heart Failure / Q000150:complications*; D006352:Heart Ventricles / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D011446:Prospective Studies; D013318:Stroke Volume; D016019:Survival Analysis; D013548:Sweden
keywords: Atrial fibrillation; Heart failure; Preserved ejection fraction; Prognosis