Comorbidities Associated with One-Year Mortality in Patients with Atrial Fibrillation and Heart Failure.

Ruxandra Nicoleta Horodinschi,Camelia Cristina Diaconu

doi:10.3390/healthcare9070830

Abstract

Background: Heart failure (HF) and atrial fibrillation (AF) commonly coexist and patients with both diseases have a worse prognosis than those with HF or AF alone. The objective of our study was to identify the factors associated with one-year mortality in patients with HF and AF, depending on the left ventricular ejection fraction (LVEF). Methods: We included 727 patients with HF and AF consecutively admitted in a clinical emergency hospital between January 2018 and December 2019. The inclusion criteria were age of more than 18 years, diagnosis of chronic HF and AF (paroxysmal, persistent, permanent), and signed informed consent. The exclusion criteria were the absence of echocardiographic data, a suboptimal ultrasound view, and other cardiac rhythms than AF. The patients were divided into 3 groups: group 1 (337 patients with AF and HF with reduced ejection fraction (HFrEF)), group 2 (112 patients with AF and HF with mid-range ejection fraction (HFmrEF)), and group 3 (278 patients with AF and HF with preserved ejection fraction (HFpEF)). Results: The one-year mortality rates were 36.49% in group 1, 27.67% in group 2, and 27.69% in group 3. The factors that increased one-year mortality were chronic kidney disease (OR 2.35, 95% CI 1.45–3.83), coronary artery disease (OR 1.67, 95% CI 1.06–2.62), and diabetes (OR 1.66, 95% CI 1.05–2.67) in patients with HFrEF; and hypertension in patients with HFpEF (OR 2.45, 95% CI 1.36–4.39). Conclusions: One-year mortality in patients with HF and AF is influenced by different factors, depending on the LVEF.

Highlights

Heart failure (HF) and atrial fibrillation (AF) are common cardiac diseases, which are frequently related and share common risk factors, such as old age, hypertension (HT), coronary artery disease (CAD), valvular heart disease, diabetes mellitus (DM), and chronic kidney disease (CKD) [1,2,3,4,5]
The New York Heart Association (NYHA) classification provides a simple way to characterize the symptoms of HF, as follows: NYHA class I—no limitation of physical exercise; NYHA class II—mild limitation of physical exercise, ordinary physical activity leads to fatigue, dyspnea, but comfortable at rest; NYHA class III—important limitation of physical activity, less than ordinary activity leads to fatigue, dyspnea, comfortable at rest; NYHA class IV—dyspnea at rest, unable to do any physical exercise without discomfort [1]
The proportion of females was greater compared to males (60.08% versus 39.92%) in the group of patients with HF with preserved ejection fraction (HFpEF)

Summary

Introduction

Heart failure (HF) and atrial fibrillation (AF) are common cardiac diseases, which are frequently related and share common risk factors, such as old age, hypertension (HT), coronary artery disease (CAD), valvular heart disease, diabetes mellitus (DM), and chronic kidney disease (CKD) [1,2,3,4,5]. The diagnosis of HF is based on the presence of clinical signs and symptoms of heart failure, elevated levels of natriuretic peptides, and at least one additional criteria of relevant structural heart disease (left ventricular hypertrophy or left atrial enlargement) or diastolic dysfunction [1]. The factors that increased one-year mortality were chronic kidney disease (OR 2.35, 95% CI 1.45–3.83), coronary artery disease (OR 1.67, 95% CI 1.06–2.62), and diabetes (OR 1.66, 95% CI 1.05–2.67) in patients with

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