Author + information
- Received April 5, 2017
- Revision received April 26, 2017
- Accepted May 1, 2017
- Published online July 31, 2017.
- Ulrik Sartipy, MD, PhDa,b,∗ (, )
- Ulf Dahlström, MD, PhDc,
- Michael Fu, MD, PhDd and
- Lars H. Lund, MD, PhDa,e
- aHeart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
- bDepartment of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- cDepartment of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
- dDepartment of Medicine, Sahlgrenska University Hospital/Östra Hospital, Gothenburg, Sweden
- eDepartment of Medicine, Karolinska Institutet, Stockholm, Sweden
- ↵∗Address for correspondence:
Dr. Ulrik Sartipy, Heart and Vascular Theme, Section of Cardiothoracic Surgery, Karolinska University Hospital, SE-171 76 Stockholm, Sweden.
Objectives The study sought to assess the independent risk factors for, consequences of, and outcomes with atrial fibrillation (AF) compared with sinus rhythm (SR) in heart failure (HF) with preserved ejection fraction (HFpEF) versus HF with mid-range ejection fraction (HFmrEF) versus HF with reduced ejection fraction (HFrEF).
Background AF is common in HF, but most data are from HFrEF. The importance of AF in HFpEF and HFmrEF is less well known.
Methods In patients from 2000 to 2012 in the SwedeHF (Swedish Heart Failure Registry) registry, enriched with patient-level data from national health care registries, the authors assessed prevalence of, associations with, and prognostic impact of AF in HFpEF versus HFmrEF versus HFrEF.
Results Of 41,446 patients, 23% had HFpEF, 22% had HFmrEF, and 55% had HFrEF. The prevalence of AF was 65%, 60%, and 53% in HFpEF, HFmrEF, and HFrEF, respectively. Independent associations with AF were similar in HFpEF, HFmrEF, and HFrEF and included greater age, male, duration of HF, prior myocardial infarction, and prior stroke or transient ischemic attack (TIA). The adjusted hazard ratios for AF versus SR in HFpEF, HFmrEF, and HFrEF were the following: for death, 1.11 (95% confidence interval [CI]: 1.02 to 1.21), 1.22 (95% CI: 1.12 to 1.33), and 1.17 (95% CI: 1.11 to 1.23); for HF hospitalization or death, 1.17 (95% CI: 1.09 to 1.26), 1.29 (95% CI: 1.20 to 1.40), and 1.15 (95% CI: 1.10 to 1.20); and for stroke or TIA or death, 1.15 (95% CI: 1.07 to 1.25), 1.23 (95% CI: 1.13 to 1.34), and 1.19 (95% CI: 1.14 to 1.26).
Conclusions AF was progressively more common with increasing ejection fraction, but was associated with similar clinical characteristics in HFpEF, HFmrEF, and HFrEF. AF was associated with similarly increased risk of death, HF hospitalization, and stroke or TIA in all ejection fraction groups. In contrast, AF and SR populations were considerably different regarding associated patient characteristics and outcomes.
The Swedish Heart Failure Registry is funded by the Swedish National Board of Health and Welfare, the Swedish Association of Local Authorities and Regions, the Swedish Society of Cardiology, and the SwedeHF Research Foundation. Dr. Lund is a Swedish Research Council Clinical Researcher. This work was funded by grants to Dr. Lund’s institution from the Swedish Research Council (grants 2013-23897-104604-23 and 523-2014-2336), Swedish Heart Lung Foundation (grants 20100419 and 20120321), Stockholm County Council (grants 20110120 and 20140220), and Swedish Society of Medicine (grants 174111 and 504881) and to Dr. Sartipy’s institution from the Swedish Heart-Lung Foundation (grant 20150528), Karolinska Institutet Foundation and Funds (grant 40842), and the Mats Kleberg Foundation (grants 2015-00097 and 2016-00015). No funding agency had any role in the concept or design, data analysis or interpretation, or drafting, revision, or approval of manuscript. Dr. Dahlström has received research funding and/or honoraria from AstraZeneca and Novartis. Dr. Fu has received research funding and/or honoraria from AstraZeneca, Novartis, TrioMED, and Servier. Dr. Lund has received research funding and/or honoraria from AstraZeneca, Novartis, Bayer, ViforPharma, Relypsa, Boston Scientific, and HeartWare. Dr. Sartipy has reported that he has no relationships relevant to the contents of this paper to disclose.
- Received April 5, 2017.
- Revision received April 26, 2017.
- Accepted May 1, 2017.
- 2017 American College of Cardiology Foundation