Abstract 12813: Atrial Fibrillation and Heart Failure With Preserved Ejection Fraction: A Systematic Review and Meta-analysis

Abstract

Introduction: Due to shared risk factors and pathophysiology, atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF) frequently coexist. However, the prognostic implications of AF in HFpEF are unclear with conflicting data. Herein, we conducted a systematic review and meta-analysis to assess the impact of concomitant AF on cardiovascular outcomes in patients with HFpEF. Methods: PubMed, Scopus, and Google Scholar were comprehensively searched through May 7th, 2020 for studies comparing outcomes of HFpEF patients with and without AF. Outcomes assessed were all-cause mortality and a composite of HF hospitalization or cardiovascular (CV) mortality. Data from selected studies were abstracted and pooled using a random-effects meta-analysis to calculate odds ratios (ORs) and 95% confidence intervals [CIs] for each of the outcomes. Results: Our final analysis included 10 studies with 27,440 HFpEF patients (43.2% with AF). AF was associated with significantly increased risk of all-cause mortality (OR 1.37 [1.17-1.61], p < 0.001, Fig. 1A), HF hospitalization or CV mortality (OR 1.66 [1.16-2.36], p = 0.005, Fig. 1B), and HF hospitalization alone (OR 1.34 [1.03-1.76], p = 0.03, Fig. 1C). However, AF was not associated with excess risk of CV mortality alone (OR 1.10 [0.79-1.52], p = 0.57, Fig. 1D). Conclusions: In patients with HFpEF, concomitant AF is associated with an increased risk of all-cause mortality and HF hospitalization. Further research into the mechanisms and interventions to mitigate this excess risk is necessary.

Are arrhythmias the drivers of sudden cardiac death in heart failure with preserved ejection fraction? A review

“…The true burden of lethal and non‐lethal (apart from AF) arrhythmias and their impact on morbidity and survival in HFpEF remain elusive. 9 , 10 , 69 , 70 , 71 , 72 It remains unknown whether SCD that accounts for 25–30% of all deaths in HFpEF patients is driven by malignant arrhythmias, and thus potentially preventable. 12 , 18 , 20 Studies aimed at determining the incidence and risk of arrhythmias as well as their predictive effect on mortality and heart failure hospitalization are urgently needed.…”

“…The true burden of lethal and non‐lethal (apart from AF) arrhythmias and their impact on morbidity and survival in HFpEF remain elusive 9,10,69–72 . It remains unknown whether SCD that accounts for 25–30% of all deaths in HFpEF patients is driven by malignant arrhythmias, and thus potentially preventable 12,18,20 .…”

“…AF is present in ~45% of HFpEF patients, and the presence of AF in these patients is associated with an increased risk of all‐cause mortality, heart failure hospitalization, and stroke. 9 , 10 , 69 , 70 , 71 , 72 The prevalence and incidence of AF is higher in the HFpEF population compared with HFrEF and appears to increase proportionally with increasing LVEF in the setting of heart failure. 9 , 70 , 71 , 73 Possible explanations of high concurrent occurrence of HFpEF and AF is the fact they share similar risk factors like hypertension, diabetes, and obesity, as well as the fact that elevated ventricular filling pressure seen in HFpEF might lead to left atrial dilatation, fibrosis, and AF.…”

Atrial fibrillation and risk of adverse outcomes in heart failure with reduced, mildly reduced, and preserved ejection fraction: A systematic review and meta‐analysis

“…The presence of AF is more strongly associated with incident HFpEF when compared to HFrEF, but uncertain for HFmrEF. [14][15][16][17] There is an approximately two to fivefold increased risk of AF in HF patients and vice versa during long-term follow up, with the risk increasing with severity of baseline disease. The rate of coexistence of AF and HF increases concomitantly with age and their joint presence is associated with greater risk of all-cause mortality and other adverse cardiovascular outcomes.…”

“…On the other hand, 30−40% of AF patients have HF. The presence of AF is more strongly associated with incident HFpEF when compared to HFrEF, but uncertain for HFmrEF 14–17 . There is an approximately two to fivefold increased risk of AF in HF patients and vice versa during long‐term follow up, with the risk increasing with severity of baseline disease.…”