Author + information
- Received April 23, 2013
- Revision received October 29, 2013
- Accepted November 12, 2013
- Published online February 1, 2014.
- Prateeti Khazanie, MD, MPH∗,†,
- Li Liang, PhD∗,
- Laura G. Qualls, MS∗,
- Lesley H. Curtis, PhD∗,†,
- Gregg C. Fonarow, MD‡,
- Bradley G. Hammill, MS∗,
- Stephen C. Hammill, MD§,
- Paul A. Heidenreich, MD, MS‖,
- Frederick A. Masoudi, MD, MSPH¶,
- Adrian F. Hernandez, MD, MHS∗,† and
- Jonathan P. Piccini, MD, MHS∗,†∗ ()
- ∗Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
- †Department of Medicine, Duke University School of Medicine, Durham, North Carolina
- ‡Ahmanson-UCLA Cardiomyopathy Center, Los Angeles, California
- §Mayo Clinic, Rochester, Minnesota
- ‖Veterans Affairs Palo Alto Health Care System, Palo Alto, California
- ¶University of Colorado Anschutz Medical Campus, Aurora, Colorado
- ↵∗Reprint requests and correspondence:
Dr. Jonathan P. Piccini, Duke Clinical Research Institute, P.O. Box 17969, Durham, North Carolina 27715.
Objectives This study sought to examine the long-term outcomes of patients hospitalized with heart failure and atrial fibrillation.
Background Atrial fibrillation is common among patients hospitalized with heart failure. Associations of pre-existing and new-onset atrial fibrillation with long-term outcomes are unclear.
Methods We analyzed 27,829 heart failure admissions between 2006 and 2008 at 281 hospitals in the American Heart Association's Get With The Guidelines–Heart Failure program linked with Medicare claims. Patients were classified as having pre-existing, new-onset, or no atrial fibrillation. Cox proportional hazards models were used to identify factors that were independently associated with all-cause mortality, all-cause readmission, and readmission for heart failure, stroke, and other cardiovascular disease at 1 and 3 years.
Results After multivariable adjustment, pre-existing atrial fibrillation was associated with greater 3-year risks of all-cause mortality (hazard ratio [HR]: 1.14 [99% confidence interval (CI): 1.08 to 1.20]), all-cause readmission (HR: 1.09 [99% CI: 1.05 to 1.14]), heart failure readmission (HR: 1.15 [99% CI: 1.08 to 1.21]), and stroke readmission (HR: 1.20 [99% CI: 1.01 to 1.41]), compared with no atrial fibrillation. There was also a greater hazard of mortality at 1 year among patients with new-onset atrial fibrillation (HR: 1.12 [99% CI: 1.01 to 1.24]). Compared with no atrial fibrillation, new-onset atrial fibrillation was not associated with a greater risk of the readmission outcomes. Stroke readmission rates at 1 year were just as high for patients with preserved ejection fraction as for patients with reduced ejection fraction.
Conclusions Both pre-existing and new-onset atrial fibrillation were associated with greater long-term mortality among older patients with heart failure. Pre-existing atrial fibrillation was associated with greater risk of readmission.
- atrial fibrillation
- heart failure
- outcome assessment (health care)
- patient readmission
This study was funded under contract HHSA29020050032I (Duke University DEcIDE Center) from the Agency for Healthcare Research and Quality, the U.S. Department of Health and Human Services, as part of the DEcIDE (Developing Evidence to Inform Decisions about Effectiveness) program. The authors of this report are responsible for its content. Statements in the report should not be construed as endorsement by the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services. Dr. Curtis has received research grants from GlaxoSmithKline and Johnson & Johnson. Dr. Fonarow has received grant funding and other research support from GlaxoSmithKline, the Agency for Healthcare Research and Quality, and the National Heart, Lung, and Blood Institute; has received honoraria from Boston Scientific/Guidant, GlaxoSmithKline, Medtronic, Merck, Novartis, Pfizer, and St. Jude Medical; has served as a consultant for Amgen, Gambro, GlaxoSmithKline, Medtronic, Merck, Novartis, Pfizer, Relypsa, Scios, and St. Jude Medical; holds the Eliot Corday Chair in Cardiovascular Medicine at UCLA; and is supported by the Ahmanson Foundation. Dr. Masoudi has received salary support through his institution from the American College of Cardiology and the Oklahoma Foundation for Medical Quality; and has received payment for editorial board services from the American Heart Association and the Massachusetts Medical Society. Dr. Hernandez has received grant funding from Amylin Pharmaceuticals and Johnson & Johnson; and honoraria from AstraZeneca, Corthera, and sanofi-aventis. Dr. Piccini has served as a consultant for Forest Laboratories, Pfizer, Medtronic, and Bristol-Myers Squibb; received grant funding from Janssen Pharmaceuticals, Boston Scientific, and GE Healthcare; and participated on advisory boards for sanofi-aventis and Johnson & Johnson. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. William Stevenson, MD, acted as Guest Editor for this paper.
- Received April 23, 2013.
- Revision received October 29, 2013.
- Accepted November 12, 2013.
- American College of Cardiology Foundation