Parag Goyal1, Zaid I Almarzooq2, Jim Cheung3, Hooman Kamel4, Udhay Krishnan3, Dmitriy N Feldman3, Evelyn M Horn3, Luke K Kim3. 1. Division of Cardiology, Department of Medicine, Weill Cornell Medicine, 520 East 70th St, New York, NY 10021, United States; Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, 520 East 70th St, New York, NY 10021, United States. Electronic address: pag9051@med.cornell.edu. 2. Department of Medicine, Weill Cornell Medicine, 525 East 68th St, New York, NY 10065, United States. 3. Division of Cardiology, Department of Medicine, Weill Cornell Medicine, 520 East 70th St, New York, NY 10021, United States. 4. Department of Neurology, Weill Cornell Medicine, 520 East 70th St, New York, NY 10021, United States.
Abstract
BACKGROUND: Atrial fibrillation (AF) and heart failure often occur concomitantly, representing a clinical phenotype at high-risk for poor outcomes. Differences in the characteristics, management, and in-hospital outcomes of AF among those with heart failure with preserved ejection fraction (HFpEF) and those with heart failure with reduced ejection fraction (HFrEF) are not well characterized. METHODS AND RESULTS: Using the National Inpatient Sample, we identified hospitalizations in 2008-2012 for HFpEF and for HFrEF, with and without AF based on ICD-9-CM codes. We examined patient characteristics, procedural rates, and in-hospital outcomes. AF was common among both HFpEF and HFrEF, and increased in prevalence over the study period. A very low proportion of the cohort underwent either direct-current cardioversion or catheter-ablation. Compared to those without AF, those with AF experienced higher in-hospital mortality regardless of heart failure subtype. In multivariable regression analysis, AF was associated with in-hospital mortality in HFpEF (OR 1.10, CI [1.08-1.11]), but not in HFrEF (OR 0.93 [0.92-0.94], p-for-interaction < 0.001). CONCLUSIONS: Our study revealed that the prevalence and adverse impact of AF on those with HFpEF is substantial, providing a rationale to rigorously investigate strategies, such as rhythm-control, to improve outcomes for this particularly vulnerable subpopulation.
BACKGROUND: Atrial fibrillation (AF) and heart failure often occur concomitantly, representing a clinical phenotype at high-risk for poor outcomes. Differences in the characteristics, management, and in-hospital outcomes of AF among those with heart failure with preserved ejection fraction (HFpEF) and those with heart failure with reduced ejection fraction (HFrEF) are not well characterized. METHODS AND RESULTS: Using the National Inpatient Sample, we identified hospitalizations in 2008-2012 for HFpEF and for HFrEF, with and without AF based on ICD-9-CM codes. We examined patient characteristics, procedural rates, and in-hospital outcomes. AF was common among both HFpEF and HFrEF, and increased in prevalence over the study period. A very low proportion of the cohort underwent either direct-current cardioversion or catheter-ablation. Compared to those without AF, those with AF experienced higher in-hospital mortality regardless of heart failure subtype. In multivariable regression analysis, AF was associated with in-hospital mortality in HFpEF (OR 1.10, CI [1.08-1.11]), but not in HFrEF (OR 0.93 [0.92-0.94], p-for-interaction < 0.001). CONCLUSIONS: Our study revealed that the prevalence and adverse impact of AF on those with HFpEF is substantial, providing a rationale to rigorously investigate strategies, such as rhythm-control, to improve outcomes for this particularly vulnerable subpopulation.
Authors: Jonathan P Piccini; Moritz F Sinner; Melissa A Greiner; Bradley G Hammill; João D Fontes; James P Daubert; Patrick T Ellinor; Adrian F Hernandez; Allan J Walkey; Susan R Heckbert; Emelia J Benjamin; Lesley H Curtis Journal: Circulation Date: 2012-09-26 Impact factor: 29.690
Authors: Clyde W Yancy; Margarita Lopatin; Lynne Warner Stevenson; Teresa De Marco; Gregg C Fonarow Journal: J Am Coll Cardiol Date: 2005-12-15 Impact factor: 24.094
Authors: Denis Roy; Mario Talajic; Stanley Nattel; D George Wyse; Paul Dorian; Kerry L Lee; Martial G Bourassa; J Malcolm O Arnold; Alfred E Buxton; A John Camm; Stuart J Connolly; Marc Dubuc; Anique Ducharme; Peter G Guerra; Stefan H Hohnloser; Jean Lambert; Jean-Yves Le Heuzey; Gilles O'Hara; Ole Dyg Pedersen; Jean-Lucien Rouleau; Bramah N Singh; Lynne Warner Stevenson; William G Stevenson; Bernard Thibault; Albert L Waldo Journal: N Engl J Med Date: 2008-06-19 Impact factor: 91.245
Authors: Mohammed N Khan; Pierre Jaïs; Jennifer Cummings; Luigi Di Biase; Prashanthan Sanders; David O Martin; Josef Kautzner; Steven Hao; Sakis Themistoclakis; Raffaele Fanelli; Domenico Potenza; Raimondo Massaro; Oussama Wazni; Robert Schweikert; Walid Saliba; Paul Wang; Amin Al-Ahmad; Salwa Beheiry; Pietro Santarelli; Randall C Starling; Antonio Dello Russo; Gemma Pelargonio; Johannes Brachmann; Volker Schibgilla; Aldo Bonso; Michela Casella; Antonio Raviele; Michel Haïssaguerre; Andrea Natale Journal: N Engl J Med Date: 2008-10-23 Impact factor: 91.245
Authors: Dipak Kotecha; Carolyn S P Lam; Dirk J Van Veldhuisen; Isabelle C Van Gelder; Adriaan A Voors; Michiel Rienstra Journal: J Am Coll Cardiol Date: 2016-11-15 Impact factor: 24.094
Authors: Rajalakshmi Santhanakrishnan; Na Wang; Martin G Larson; Jared W Magnani; David D McManus; Steven A Lubitz; Patrick T Ellinor; Susan Cheng; Ramachandran S Vasan; Douglas S Lee; Thomas J Wang; Daniel Levy; Emelia J Benjamin; Jennifer E Ho Journal: Circulation Date: 2016-01-08 Impact factor: 29.690
Authors: Manuel Rattka; Alexander Pott; Anna Kühberger; Karolina Weinmann; Dominik Scharnbeck; Tilman Stephan; Michael Baumhardt; Carlo Bothner; Mario Iturbe Orbe; Wolfgang Rottbauer; Tillman Dahme Journal: Europace Date: 2020-09-01 Impact factor: 5.214
Authors: Sana M Al-Khatib; Emelia J Benjamin; Christine M Albert; Alvaro Alonso; Cynthia Chauhan; Peng-Sheng Chen; Anne B Curtis; Patrice Desvigne-Nickens; Jennifer E Ho; Carolyn S P Lam; Mark S Link; Kristen K Patton; Margaret M Redfield; Michiel Rienstra; Yves Rosenberg; Renate Schnabel; John A Spertus; Lynne Warner Stevenson; Mellanie True Hills; Adriaan A Voors; Lawton S Cooper; Alan S Go Journal: Circulation Date: 2020-06-08 Impact factor: 29.690