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The impact of atrial fibrillation on clinical outcomes in heart failure with mid-range and preserved ejection
Irina Mustafina1, Khaled Elkholey2, Marat Fudim3
1Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; Department of Internal Medicine, Bashkir State Medical University, Ufa, Russia.
Heart Rhythm
|May 26, 2024
Summary
Atrial fibrillation (AF) independently worsens outcomes in heart failure (HF) patients across all left ventricular ejection fraction (LVEF) ranges. This finding highlights AF as a critical factor impacting HF prognosis regardless of LVEF severity.
Area of Science:
- Cardiology
- Clinical Medicine
- Heart Failure Research
Background:
- The interplay between left ventricular ejection fraction (LVEF) and atrial fibrillation (AF) in heart failure (HF) outcomes is complex.
- Understanding this relationship is crucial for effective HF management.
Purpose of the Study:
- To analyze the impact of AF on clinical outcomes in HF patients.
- Stratify HF patients by LVEF ranges: HF with mid-range ejection fraction (HFmrEF), HF with preserved ejection fraction (HFpEF), and HF with normal ejection fraction (HFnEF).
Main Methods:
- Post hoc analysis of the TOPCAT trial data.
- Included 3442 patients stratified into three LVEF groups.
- Utilized Cox regression to assess independent associations between AF and clinical outcomes.
Main Results:
- AF prevalence was significant across all LVEF groups (33.7%-38.6%).
- AF was linked to worse primary outcomes in all subgroups.
- AF increased HF hospitalizations and cardiovascular mortality in HFpEF and HFnEF patients.
Conclusions:
- Atrial fibrillation is an independent predictor of adverse outcomes in heart failure patients.
- The negative impact of AF on HF outcomes persists across the spectrum of LVEF.
- Managing AF is critical for improving prognosis in diverse HF populations.
Keywords:
Atrial fibrillationHeart failureHeart failure with preserved ejection fractionLeft ventricular ejection fractionRisk assessmentMore Related Videos
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