Temporal Relationship between Atrial Fibrillation and Heart Failure Development Analysis from a Nationwide Database

Area of Science:

• Cardiology
• Clinical Medicine
• Epidemiology

Background:

• Atrial fibrillation (AF) and heart failure (HF) frequently coexist, exacerbating each other.
• The temporal relationship between AF and HF onset significantly impacts patient prognosis.
• Previous research has not fully elucidated the outcomes based on the chronological order of AF and HF development.

Purpose of the Study:

• To investigate the clinical outcomes of patients hospitalized with both AF and HF.
• To compare outcomes based on whether HF preceded AF (prevalent HF) or AF preceded HF (incident HF).

Main Methods:

• Analysis of a large administrative database of the entire French population (2010-2018).
• Identification of 1,349,638 patients with both AF and HF.
• Propensity score matching used for outcome analysis in 427,848 patients, comparing prevalent HF vs. incident HF groups.

Main Results:

• Patients with prevalent HF exhibited significantly higher risks of all-cause death (HR 1.10) and cardiovascular death (HR 1.14) compared to incident HF.
• Re-hospitalization for HF was substantially higher in the prevalent HF group (HR 1.44).
• Conversely, the risk of ischemic stroke was lower in patients with prevalent HF (HR 0.50).

Conclusions:

• Two distinct clinical trajectories exist for patients with concurrent AF and HF.
• Prevalent HF is associated with poorer survival and increased HF re-hospitalization rates.
• The chronological sequence of AF and HF onset is a critical determinant of patient outcomes.