Abstract 2011: Increasing Prevalence of Atrial Fibrillation in Acute Decompensated Heart Failure
Background: Atrial fibrillation (AF) is a common precipitant of decompensation and hospitalization for heart failure (HF). While studies suggest an increasing prevalence of AF in the community, reports of long term trends in hospitalized HF cohorts are lacking. Furthermore, whether AF is associated with increased mortality among patients with acutely decompensated HF (ADHF) is unclear. Our objectives were to define secular trends in the prevalence of AF in ADHF and to define the effect of AF on outcome in ADHF.
Methods: We characterized 6076 unique consecutive patients admitted with ADHF to Mayo Clinic hospitals in Rochester, MN between January 1, 1987, and December 31, 2001. Of those, 4596 (76%) had ejection fraction (EF) measured within 30 days with 2167 (47%) having HF with preserved (≥50%) EF (HFnlEF) and 2429 having HF with reduced EF (systolic HF, SHF).
Results: In the entire cohort, the prevalence of AF increased over time (28%, 31% and 38% over the three consecutive five year periods included in the study, p<0.0001) and this trend remained significant after adjusting for changes in patient characteristics (age, sex, creatinine, hemoglobin, presence of coronary disease, hypertension or diabetes) over time. Survival was not related to AF (HR = 1.02, 95% CI 0.99 –1.05, p = 0.25), even when adjusting for differences in patient characteristics (adjusted HR = 0.99, CI 0.96 –1.02, p = 0.46). Among those HF patients with EF measurement, AF was more common in HFnlEF than in SHF (41 vs 29%, p <0.0001) and prevalence increased in both SHF (23%, 27% and 36%; p<0.0001) and HFnlEF (38%, 39% and 45%; p = 0.012) over the three consecutive 5-year periods. This trend remained significant in SHF but not HFnlEF after adjusting for changes in patient characteristics over time. AF was not associated with mortality in SHF or in HFnlEF, even after adjusting for differences in patient characteristics.
Conclusion: The increasing prevalence of AF among patients admitted with ADHF over time and regardless of HF type indicates the growing importance of AF as a factor influencing HF hospitalization, if not HF mortality and underscores the need to define optimal management strategies for AF in HF patients.