Heart failure in patients with atrial fibrillation: Insights from Polish part of the EORP-AF general long-term registry.

Abstract

This study aimed to determine the impact of heart failure (HF) on clinical outcomes in patients with atrial fibrillation (AF). We analysed data from Polish participants of the EURObservational Research Programme-AF General Long-Term Registry. The primary endpoint was all-cause death, and the secondary endpoints included hospital readmissions, cardiovascular (CV) interventions, thromboembolic and haemorrhagic events, rhythm control interventions, and other CV or non-CV diseases development during one-year follow up. Overall, 688 patients with available data on HF were included into analysis; 51% (n=351) had HF; of these 48% (n=168) had reduced ejection fraction (HFrEF), 22% (n=77) mid-range EF (HFmrEF), and 30% (n=106) preserved EF (HFpEF). Compared with patients without HF, those with HF had higher mortality rate (aHR 5.61; 95% CI 1.94-16.22, P<0.01). Patients with HF (vs. without HF) had more often CV interventions (10% vs. 5.4%, P=0.046) and events (14% vs. 7.1%, P=0.02), and had less often atrial arrhythmia-related hospital admissions (6.8% vs. 15%, P<0.01). Over follow-up, patients with HFmrEF and HFpEF had similar mortality rate versus HFrEF (aHR 0.45, 95% CI 0.13-1.57, P=0.45 for HFmrEF and aHR 0.54, 95% CI 0.20-1.48, P=0.54 for HFpEF). Mortality rate was similar among rhythm versus rate control group (aHR 0.34; 95% CI 0.10-1.16; P=0.34). AF patients with HF have greater mortality rate and more CV interventions/events. No statistically significant difference in long-term outcomes between patients with HFrEF, HFmrEF, and HFpEF highlights the need to develop therapeutic strategies targeting functional status and survival for patients with HF and AF.