Atrial Fibrillation Begets Heart Failure and Vice Versa

Abstract

Background Atrial fibrillation (AF) and heart failure (HF) frequently coexist and together confer an adverse prognosis. The association of AF with HF subtypes has not been well-described. We sought to examine differences in the temporal association of AF and HF with preserved versus reduced ejection fraction (HFpEF vs HFrEF). Methods and Results We studied Framingham Heart Study participants with new-onset AF and/or HF between 1980–2012. Among 1737 individuals with new AF, (mean-age 75±12, 48% women) more than one third (37%) had HF. Conversely among 1166 individuals with new HF (mean-age 79±11, 53% women), more than half (57%) had AF. Prevalent AF was more strongly associated with incident HFpEF (multivariable-adjusted hazard ratio [HR] 2.34, 95% confidence interval [CI] 1.48–3.70, no AF as referent) vs HFrEF (HR 1.32, 95%CI 0.83–2.10), with a trend toward difference between HF subtypes (P for difference 0.06). Prevalent HF was associated with incident AF (HR 2.18, 95%CI 1.26–3.76, no HF as referent). The presence of both AF and HF portended greater mortality risk compared with those without either condition, particularly among individuals with new HFrEF and prevalent AF (HR 2.72, 95%CI 2.12–3.48) compared with new HFpEF and prevalent AF (HR 1.83, 95%CI 1.41–2.37, P for difference 0.02). Conclusions AF occurs in more than half of individuals with HF, and HF in more than one third of individuals with AF. AF precedes and follows both HFpEF and HFrEF, with some differences in temporal association and prognosis. Future studies focused on underlying mechanisms of these dual conditions are warranted.

Phenotype-Specific Treatment of Heart Failure With Preserved Ejection Fraction

“…Incident atrial fibrillation in HFpEF also accompanies worse LV diastolic dysfunction and was inversely related to statin use 62 . Prevalent atrial fibrillation was shown to be associated with incident HFpEF and prevalent HFpEF with incident atrial fibrillation 154 . These interactions suggest atrial fibrillation to beget HFpEF and vice versa and suggest efforts to restore sinus rhythm could be included in a HFpEF treatment strategy.…”

Cardiac aging and heart disease in humans

“…Two important players of agerelated structural remodeling of the heart-LV concentric hypertrophy and atrial dilation-are therefore associated with the two main cardiac pathologies of old age: HFpEF and atrial fibrillation. These two pathologies often occur together, with two-thirds of HFpEF patients at some point presenting with atrial fibrillation and with most patients first developing atrial fibrillation and then heart failure (Santhanakrishnan et al 2016).…”

Outcomes of Rate-Control Treatment in Patients With Atrial Fibrillation and Heart Failure ― A Nationwide Cohort Study ―

“…27 Reduced cardiac output is substantial in patients with HF and can cause serious clinical symptoms. 28 For example, sustained tachycardia can lead to dilatation of the left ventricle and left ventricular systolic dysfunction, resulting in tachycardiainduced cardiomyopathy. 29 In patients with AF-associated HF requiring hospitalization, tachycardia-induced cardiomyopathy is presumably the cause in approximately onethird of the patients without any known structural heart disease.…”