Atrial Fibrillation and Outcomes in Heart Failure With Preserved Versus Reduced Left Ventricular Ejection Fraction

Abstract

Background Atrial fibrillation ( AF ) and heart failure ( HF ) are 2 of the most common cardiovascular conditions nationally and AF frequently complicates HF . We examined how AF has impacts on adverse outcomes in HF ‐ PEF versus HF ‐ REF within a large, contemporary cohort. Methods and Results We identified all adults diagnosed with HF ‐ PEF or HF ‐ REF based on hospital discharge and ambulatory visit diagnoses and relevant imaging results for 2005–2008 from 4 health plans in the Cardiovascular Research Network. Data on demographic features, diagnoses, procedures, outpatient pharmacy use, and laboratory results were ascertained from health plan databases. Hospitalizations for HF , stroke, and any reason were identified from hospital discharge and billing claims databases. Deaths were ascertained from health plan and state death files. Among 23 644 patients with HF , 11 429 (48.3%) had documented AF (9081 preexisting, 2348 incident). Compared with patients who did not have AF , patients with AF had higher adjusted rates of ischemic stroke (hazard ratio [ HR ] 2.47 for incident AF ; HR 1.57 for preexisting AF ), hospitalization for HF ( HR 2.00 for incident AF ; HR 1.22 for preexisting AF ), all‐cause hospitalization ( HR 1.45 for incident AF ; HR 1.15 for preexisting AF ), and death (incident AF HR 1.67; preexisting AF HR 1.13). The associations of AF with these outcomes were similar for HF ‐ PEF and HF ‐ REF , with the exception of ischemic stroke. Conclusions AF is a potent risk factor for adverse outcomes in patients with HF ‐ PEF or HF ‐ REF . Effective interventions are needed to improve the prognosis of these high‐risk patients.