Circulation. 2003;107:2920-2925
Published online before print May 27, 2003, doi: 10.1161/01.CIR.0000072767.89944.6E
Published online before print May 27, 2003, doi: 10.1161/01.CIR.0000072767.89944.6E
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(Circulation. 2003;107:2920.)
© 2003 American Heart Association, Inc.
Clinical Investigation and Reports |
Temporal Relations of Atrial Fibrillation and Congestive Heart Failure and Their Joint Influence on Mortality
The Framingham Heart Study
From the Framingham Heart Study (all authors), Framingham, Mass; Cardiology Division (T.J.W.), Massachusetts General Hospital, Harvard Medical School, Boston, Mass; Sections of Cardiology (D.L., R.S.V., E.J.B.), Preventive Medicine (M.G.L., D.L., R.S.V., J.M.M., W.B.K., E.J.B.), Neurology (P.A.W.), and General Internal Medicine (J.M.M.), Boston University School of Medicine, Boston, Mass; National Heart, Lung, and Blood Institute (D.L.), Bethesda, Md; and Department of Mathematics (R.B.D.), Boston University, Boston, Mass.
Correspondence to Dr Emelia Benjamin, Framingham Heart Study, 73 Mt Wayte Ave, Suite #2, Framingham, MA 01702-5827. E-mail emelia{at}bu.edu
Background— Atrial fibrillation (AF) and congestive heart failure (CHF) frequently occur together, but there is limited information regarding their temporal relations and the combined influence of these conditions on mortality.
Methods and Results— We studied participants in the Framingham Study with new-onset AF or CHF. Multivariable Cox proportional hazards models with time-dependent variables were used to evaluate whether mortality after AF or CHF was affected by the occurrence and timing of the other condition. Hazard ratios (HRs) were adjusted for time period and cardiovascular risk factors. During the study period, 1470 participants developed AF, CHF, or both. Among 382 individuals with both conditions, 38% had AF first, 41% had CHF first, and 21% had both diagnosed on the same day. The incidence of CHF among AF subjects was 33 per 1000 person-years, and the incidence of AF among CHF subjects was 54 per 1000 person-years. In AF subjects, the subsequent development of CHF was associated with increased mortality (men: HR 2.7; 95% CI, 1.9 to 3.7; women: HR 3.1; 95% CI, 2.2 to 4.2). Similarly, in CHF subjects, later development of AF was associated with increased mortality (men: HR 1.6; 95% CI, 1.2 to 2.1; women: HR 2.7, 95% CI, 2.0 to 3.6). Preexisting CHF adversely affected survival in individuals with AF, but preexisting AF was not associated with adverse survival in those with CHF.
Conclusions— Individuals with AF or CHF who subsequently develop the other condition have a poor prognosis. Additional studies addressing the pathogenesis, prevention, and optimal management of the joint occurrence of AF and CHF appear warranted.
Key Words: arrhythmia • fibrillation, atrial • heart failure • mortality
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A. Ahmed and G. J. Perry Incident atrial fibrillation and mortality in older adults with heart failure Eur J Heart Fail, December 1, 2005; 7(7): 1118 - 1121. [Abstract] [Full Text] [PDF]
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R. Nieuwlaat, A. Capucci, A. J. Camm, S. B. Olsson, D. Andresen, D. W. Davies, S. Cobbe, G. Breithardt, J.-Y. Le Heuzey, M. H. Prins, et al. Atrial fibrillation management: a prospective survey in ESC Member Countries: The Euro Heart Survey on Atrial Fibrillation Eur. Heart J., November 2, 2005; 26(22): 2422 - 2434. [Abstract] [Full Text] [PDF]
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G. V. Naccarelli Antiadrenergic Therapy in the Control of Atrial Fibrillation Journal of Cardiovascular Pharmacology and Therapeutics, October 1, 2005; 10(4_suppl): S33 - S43. [Abstract] [PDF]
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P. Zimetbaum An Argument for Maintenance of Sinus Rhythm in Patients With Atrial Fibrillation Circulation, June 14, 2005; 111(23): 3150 - 3156. [Full Text] [PDF]
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B. J. Gersh, T. S.M. Tsang, M. E. Barnes, and J. B. Seward The changing epidemiology of non-valvular atrial fibrillation: the role of novel risk factors Eur. Heart J. Suppl., May 1, 2005; 7(suppl_C): C5 - C11. [Abstract] [Full Text] [PDF]
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P. T. Ellinor, A. F. Low, K. K. Patton, M. A. Shea, and C. A. MacRae Discordant atrial natriuretic peptide and brain natriuretic peptide levels in lone atrial fibrillation J. Am. Coll. Cardiol., January 4, 2005; 45(1): 82 - 86. [Abstract] [Full Text] [PDF]
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J. J.V. McMurray and M. A. Pfeffer The year in heart failure J. Am. Coll. Cardiol., December 21, 2004; 44(12): 2398 - 2405. [Full Text] [PDF]
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L.-F. Hsu, P. Jais, P. Sanders, S. Garrigue, M. Hocini, F. Sacher, Y. Takahashi, M. Rotter, J.-L. Pasquie, C. Scavee, et al. Catheter Ablation for Atrial Fibrillation in Congestive Heart Failure N. Engl. J. Med., December 2, 2004; 351(23): 2373 - 2383. [Abstract] [Full Text] [PDF]
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T.-J. Cha, J. R. Ehrlich, L. Zhang, and S. Nattel Atrial Ionic Remodeling Induced by Atrial Tachycardia in the Presence of Congestive Heart Failure Circulation, September 21, 2004; 110(12): 1520 - 1526. [Abstract] [Full Text] [PDF]
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D. Dobrev, T. Christ, and U. Ravens Muscarinic subtype-2 receptor autoantibodies: actors or bystanders in human atrial fibrillation? Eur. Heart J., July 1, 2004; 25(13): 1091 - 1092. [Full Text] [PDF]
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M. S. Chen, N. F. Marrouche, Y. Khaykin, A. M. Gillinov, O. Wazni, D. O. Martin, A. Rossillo, A. Verma, J. Cummings, D. Erciyes, et al. Pulmonary vein isolation for the treatment of atrial fibrillation in patients with impaired systolic function J. Am. Coll. Cardiol., March 17, 2004; 43(6): 1004 - 1009. [Abstract] [Full Text] [PDF]
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N. Saoudi Pulmonary vein isolation for atrial fibrillation in low ejection fraction patients: the market is growing! J. Am. Coll. Cardiol., March 17, 2004; 43(6): 1010 - 1012. [Full Text] [PDF]
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D. Levy and W. B. Kannel Postoperative atrial fibrillation and mortality: do the risks merit changes in clinical practice? J. Am. Coll. Cardiol., March 3, 2004; 43(5): 749 - 751. [Full Text] [PDF]
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J. R. Folkeringa, H.J.G.M. Crijns, and D.J. Van Veldhuisen Prognosis of Atrial Fibrillation in Congestive Heart Failure Circulation, January 20, 2004; 109 (2): e11 - e11. [Full Text] [PDF]
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P. Sanders, J. B. Morton, N. C. Davidson, S. J. Spence, J. K. Vohra, P. B. Sparks, and J. M. Kalman Electrical Remodeling of the Atria in Congestive Heart Failure: Electrophysiological and Electroanatomic Mapping in Humans Circulation, September 23, 2003; 108(12): 1461 - 1468. [Abstract] [Full Text] [PDF]
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J. C. Daubert Introduction to atrial fibrillation and heart failure: a mutually noxious association Europace, January 1, 2003; 5(s1): S1 - S4. [Full Text] [PDF]
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I. Savelieva and A. John Camm Atrial fibrillation and heart failure: natural history and pharmacological treatment Europace, January 1, 2003; 5(s1): S5 - S19. [Abstract] [Full Text] [PDF]
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L. Padeletti, N. Musilli, M. C. Porciani, A. Colella, L. Di Biase, G. Ricciardi, P. Pieragnoli, A. Michelucci, and G. Gensini Atrial fibrillation and cardiac resynchronization therapy: the MASCOT study Europace, January 1, 2003; 5(s1): S49 - S54. [Abstract] [Full Text] [PDF]
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