Dipak Kotecha1, Rajiv Chudasama2, Deirdre A Lane2, Paulus Kirchhof2, Gregory Y H Lip2. 1. University of Birmingham Institute for Cardiovascular Sciences, The Medical School, Birmingham, B15 2TT, UK. Electronic address: d.kotecha@bham.ac.uk. 2. University of Birmingham Institute for Cardiovascular Sciences, The Medical School, Birmingham, B15 2TT, UK.
Abstract
BACKGROUND: Atrial fibrillation (AF) and heart failure frequently coexist, commonly resulting in serious adverse events. With both conditions increasing in prevalence and justified concerns about treatment efficacy, it is vital to understand how the type of heart failure impacts on prognosis. METHODS: We performed a systematic review of studies examining cardiovascular outcomes in AF patients with heart failure and reduced ejection fraction (AF-HFrEF) compared to those with preserved ejection fraction (AF-HFpEF). The primary outcome was all-cause mortality, meta-analyzed using a random-effects model. Prospective registration: PROSPERO-CRD42014007305. RESULTS: Thirteen studies were included in the systematic review (n=54,587) with 10 suitable for meta-analysis, including retrospective/prospective cohorts and sub-group analyses of randomized trials. AF-HFrEF was present in 49% and these patients were younger, more often male and with higher NYHA class than AF-HFpEF. Oral anticoagulation use was 55% versus 50% respectively (p<0.001). All-cause mortality was significantly higher in AF-HFrEF; risk ratio (RR) 1.24, 95% CI 1.12-1.36, p<0.001 (n=45,100), with absolute death rates of 24% compared to 18% in AF-HFpEF over 2 years. There were no significant differences in incident stroke (RR 0.85, 95% CI 0.70-1.03, p=0.094; n=33,773) or heart failure hospitalization (RR 1.21, 95% CI 0.96-1.53, p=0.115; n=31,583). The risk of bias was generally low, but heterogeneity was substantial. CONCLUSIONS: All-cause mortality is significantly higher in AF patients with HFrEF compared to HFpEF, although stroke risk and heart failure hospitalization are similar. Further studies are needed to address the prevention of adverse outcomes in all AF patients with heart failure, regardless of ejection fraction.
BACKGROUND: Atrial fibrillation (AF) and heart failure frequently coexist, commonly resulting in serious adverse events. With both conditions increasing in prevalence and justified concerns about treatment efficacy, it is vital to understand how the type of heart failure impacts on prognosis. METHODS: We performed a systematic review of studies examining cardiovascular outcomes in AF patients with heart failure and reduced ejection fraction (AF-HFrEF) compared to those with preserved ejection fraction (AF-HFpEF). The primary outcome was all-cause mortality, meta-analyzed using a random-effects model. Prospective registration: PROSPERO-CRD42014007305. RESULTS: Thirteen studies were included in the systematic review (n=54,587) with 10 suitable for meta-analysis, including retrospective/prospective cohorts and sub-group analyses of randomized trials. AF-HFrEF was present in 49% and these patients were younger, more often male and with higher NYHA class than AF-HFpEF. Oral anticoagulation use was 55% versus 50% respectively (p<0.001). All-cause mortality was significantly higher in AF-HFrEF; risk ratio (RR) 1.24, 95% CI 1.12-1.36, p<0.001 (n=45,100), with absolute death rates of 24% compared to 18% in AF-HFpEF over 2 years. There were no significant differences in incident stroke (RR 0.85, 95% CI 0.70-1.03, p=0.094; n=33,773) or heart failure hospitalization (RR 1.21, 95% CI 0.96-1.53, p=0.115; n=31,583). The risk of bias was generally low, but heterogeneity was substantial. CONCLUSIONS: All-cause mortality is significantly higher in AF patients with HFrEF compared to HFpEF, although stroke risk and heart failure hospitalization are similar. Further studies are needed to address the prevention of adverse outcomes in all AF patients with heart failure, regardless of ejection fraction.
Authors: Dipak Kotecha; Karina V Bunting; Simrat K Gill; Samir Mehta; Mary Stanbury; Jacqueline C Jones; Sandra Haynes; Melanie J Calvert; Jonathan J Deeks; Richard P Steeds; Victoria Y Strauss; Kazem Rahimi; A John Camm; Michael Griffith; Gregory Y H Lip; Jonathan N Townend; Paulus Kirchhof Journal: JAMA Date: 2020-12-22 Impact factor: 56.272
Authors: Per Wändell; Axel C Carlsson; Martin J Holzmann; Johan Ärnlöv; Jan Sundquist; Kristina Sundquist Journal: J Cardiol Date: 2018-02-01 Impact factor: 3.159
Authors: Jens Cosedis Nielsen; Yenn-Jiang Lin; Marcio Jansen de Oliveira Figueiredo; Alireza Sepehri Shamloo; Alberto Alfie; Serge Boveda; Nikolaos Dagres; Dario Di Toro; Lee L Eckhardt; Kenneth Ellenbogen; Carina Hardy; Takanori Ikeda; Aparna Jaswal; Elizabeth Kaufman; Andrew Krahn; Kengo Kusano; Valentina Kutyifa; Han S Lim; Gregory Y H Lip; Santiago Nava-Townsend; Hui-Nam Pak; Gerardo Rodríguez Diez; William Sauer; Anil Saxena; Jesper Hastrup Svendsen; Diego Vanegas; Marmar Vaseghi; Arthur Wilde; T Jared Bunch; Alfred E Buxton; Gonzalo Calvimontes; Tze-Fan Chao; Lars Eckardt; Heidi Estner; Anne M Gillis; Rodrigo Isa; Josef Kautzner; Philippe Maury; Joshua D Moss; Gi-Byung Nam; Brian Olshansky; Luis Fernando Pava Molano; Mauricio Pimentel; Mukund Prabhu; Wendy S Tzou; Philipp Sommer; Janice Swampillai; Alejandro Vidal; Thomas Deneke; Gerhard Hindricks; Christophe Leclercq Journal: Europace Date: 2020-08-01 Impact factor: 5.214