New Onset Atrial Fibrillation Predicts Heart Failure Progression.
Am J Med. 2014 Jun 12;
Authors: Aleong RG, Sauer WH, Davis G, Bristow MR
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 didn't (Group 2, n = 2202) develop new onset atrial fibrillation. Results were also compared to 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 to Group 2, Group 1 patients post-atrial-fibrillation onset had a ∼2 fold increase in mortality (p <0.0001) and a ∼4.5 fold increase in all-cause or heart failure hospitalization days/patient (hospitalization burden, both p <0.0001). In Group 1 both types of hospitalization burden were 2.9 fold greater than in the Baseline/chronic group (p <0.001), and hospitalization burden increased ∼6 fold (p <0.0001) compared to the pre-event period. On multivariate analysis new onset atrial fibrillation was a highly significant (p <0.00001) 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.
PMID: 24931393 [PubMed - as supplied by publisher]