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Asymptomatic vs. symptomatic atrial fibrillation: Clinical outcomes in heart failure patients

Giuseppe Boriani1, Niccolo' Bonini2, Marco Vitolo2

  • 1Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo, 71, Modena 41124, Italy.

European Journal of Internal Medicine
|September 27, 2023
PubMed

Insights

Asymptomatic atrial fibrillation (AF) poses a higher risk for adverse outcomes, specifically in patients with heart failure (HF) and reduced left ventricular ejection fraction (LVEF). This highlights the importance of considering AF symptom status in HF management.

Area of Science:

  • Cardiology
  • Clinical Medicine
  • Epidemiology

Background:

  • Atrial fibrillation (AF) management requires understanding outcomes in diverse patient subgroups.
  • The prognostic implications of asymptomatic versus symptomatic AF in patients with heart failure (HF) and varying left ventricular ejection fraction (LVEF) remain unclear.

Purpose of the Study:

  • To clarify the outcome differences between asymptomatic and symptomatic AF patients stratified by HF and LVEF status.
  • To investigate the independent association of asymptomatic AF with adverse events in specific HF and LVEF subgroups.

Main Methods:

  • Prospective observational study including 8096 AF patients.
  • Patients categorized into 8 groups based on overt HF presence and LVEF (≤40% or >40%).
  • Follow-up for composite outcomes (all-cause death, MACE) and analysis of asymptomatic vs. symptomatic AF impact.

Main Results:

  • No significant difference in the composite outcome between asymptomatic and symptomatic AF across the entire cohort.
  • Asymptomatic AF patients with HF and LVEF ≤40% showed significantly worse outcomes (composite outcome and all-cause death) compared to symptomatic AF patients in the same group.
  • Adjusted analysis revealed asymptomatic AF with HF and LVEF ≤40% as an independent predictor of higher risk for composite outcomes and all-cause death.

Conclusions:

  • In a large European AF cohort, asymptomatic AF did not increase overall 2-year composite outcome risk compared to symptomatic AF.
  • However, asymptomatic AF is associated with adverse outcomes in patients with heart failure and reduced left ventricular ejection fraction (LVEF ≤40%).
Abstract

Keywords:
Atrial fibrillationHeart failureLeft ventricular ejection fractionMortalityOutcome

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