Atrial Fibrillation Management in Older Heart Failure Patients: A Complex Clinical Problem

Pulignano, Giovanni; Sindaco, Donatella Del; Tinti, Maria Denitza; Tolone, Stefano; Minardi, Giovanni; Lax, Antonio; Uguccioni, Massimo

doi:10.5301/heartint.5000230

Cited by 10 publications

(5 citation statements)

References 60 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“… 5 A possible explanation may be that incident AF beyond 1 year is a marker of HF progression and/or frailty in HF. 7 , 21 Our sex-specific analysis revealed that incident AF was associated with a greater loss in expected lifetime among women than men. 22 AF is associated with higher mortality among women in the non-HF setting, and our data support recent work that shows higher mortality among women in an HF-setting.…”

Section: Discussionmentioning

confidence: 75%

Life-Years Lost After Newly Diagnosed Atrial Fibrillation in Patients with Heart Failure

Vinter¹,

Cordsen²,

Lip³

et al. 2022

CLEP

View full text Add to dashboard Cite

Objective Prior work estimated excess death rates associated with atrial fibrillation (AF) in heart failure (HF) with hazard ratios (HR). The aim was to estimate the life-years lost after newly diagnosed AF in HF patients. Methods Among patients diagnosed with HF in 2008–2018 in the nationwide Danish Heart Failure Registry, we compared patients with incident AF to referents matched on age, sex, and time since HF. We estimated the marginal hazard ratio (HR) for death and marginal difference in restricted mean survival times (RMST) between AF cases and referents at 10 years after AF diagnosis. We adjusted for sex, age at AF diagnosis, clinical and lifestyle risk factors, and medications. Results Among 4463 AF cases and 17,792 referents (mean age 73.7 years, 29% women), the HR was 1.41 (95% CI 1.38; 1.44) but there was evidence of non-proportional hazards. The difference in RMST was −18.2 months (95% CI −16.8; −19.6) at 10 years after AF diagnosis. There were differences in life-years lost between patients diagnosed with AF >1 year and ≤1 year after HF (−25.7 months, 95% CI −23.7; −27.7 vs −10.4 months, 95% CI −8.2; −12.5, p < 0.001), women and men (−20.3 months, 95% CI −17.7; −21.9 vs −17.2 months, 95% CI −15.5; −19.0, p = 0.05), patients with low, medium, and high CHA 2 DS 2 -VASc (10.3 months, 95% CI −4.6; −16.1 vs −18.5 months, 95% CI −16.7; −20.4 vs 22.1, 95% CI −18.8; −22.3, p = 0.002). Conclusion HF patients with incident AF lost on average 1.5 life-years over 10 years after AF. Life-years lost were larger among patients diagnosed with AF >1 year after HF, women, and patients with higher CHA 2 DS 2 -VASc.

show abstract

Section: Discussionmentioning

confidence: 75%

Life-Years Lost After Newly Diagnosed Atrial Fibrillation in Patients with Heart Failure

Vinter¹,

Cordsen²,

Lip³

et al. 2022

CLEP

View full text Add to dashboard Cite

show abstract

“…Compared to coronary artery disease and stroke, the differences between women and men with HF and/or AF have received less attention [ 36 ]. AF often occurs as a cause or consequence of HF [ 15 , 16 ]. Adverse outcomes are worse when AF and HF coexist [ 17 , 18 ].…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, AF prevalence also steeply increases with age [ 14 ]. Multiple relationships can exist between HF and AF, including shared risk factors and the causation of one by the other [ 14 , 15 ]. Recently, two meta-analyses have reported that the coexistence of AF in HF patients increased the odds of mortality from 14% to 57% when compared to HF alone [ 16 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, both rehospitalization and ER visits have been associated with increased healthcare costs [ 13 , 28 ]. As mentioned, comorbidities and their treatments may complicate the treatment, and patient outcomes in HF, especially, older patients [ 15 , 19 ]. Accordingly, healthcare professionals should examine the factors that can cause adverse outcomes in older patients with HF.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Sex Differences in the Association between Atrial Fibrillation and 90-Day Adverse Outcomes among Older Adults with Heart Failure: A Retrospective Cohort Study

Son

Kim

Won

2021

IJERPH

View full text Add to dashboard Cite

Sex differences in the prognostic impact of coexisting atrial fibrillation (AF) in older patients with heart failure (HF) have not been well-studied. This study, therefore, compared sex differences in the association between AF and its 90-day adverse outcomes (hospital readmissions and emergency room (ER) visits) among older adults with HF. Of the 250 older adult patients, the prevalence rates of coexisting AF between male and female HF patients were 46.0% and 31.0%, respectively. In both male and female older patients, patients with AF have a significantly higher readmission rate (male 46.0%, and female 34.3%) than those without AF (male 6.8%, and female 12.8%). However, there are no significant differences in the association between AF and ER visits in both male and female older HF patients. The multivariate logistic analysis showed that coexisting AF significantly increased the risk of 90-day hospital readmission in both male and female older patients. In addition, older age in males and longer periods of time after an HF diagnosis in females were associated with an increased risk of hospital readmission. Consequently, prospective cohort studies are needed to identify the impact of coexisting AF on short- and long-term outcomes in older adult HF patients by sex.

show abstract

“…We used G*power 3.1 to calculate the adequate sample size for this study (Faul et al, 2009 ). It was determined that the sample size of 170 patients was adequate for two‐tailed logistic regression analysis with an alpha level of 0.05, power of 90% and 1.9 odds ratio (OR) based on previous study (Pulignano et al, 2016 ); therefore, the sample size of 176 patients was sufficient.…”

Section: Methodsmentioning

confidence: 99%

Association of sleep duration and physical frailty with cognitive function in older patients with coexisting atrial fibrillation and heart failure

2022

View full text Add to dashboard Cite

Aim To investigate the associations of sleep duration and physical frailty with cognitive function in older patients with both atrial fibrillation and heart failure. Design This study used a cross‐sectional, secondary data analysis design. Method We included outpatients aged ≥ 65 years with coexisting atrial fibrillation and heart failure in South Korea. We used a sample of 176 patients (men = 100) with HF among 277 data from the parent study. The data were collected through a self‐report, structured questionnaire and electronic medical record. Results Our main finding showed that long sleep duration and physically frail status were significant predictors of cognitive impairment in older adults with both atrial fibrillation and heart failure. Healthcare providers should be aware of the importance of assessing sleep duration and physical activity in older adults with both atrial fibrillation and heart failure to prevent or delay cognitive impairment.

show abstract

Atrial Fibrillation Management in Older Heart Failure Patients: A Complex Clinical Problem

Cited by 10 publications

References 60 publications

Life-Years Lost After Newly Diagnosed Atrial Fibrillation in Patients with Heart Failure

Life-Years Lost After Newly Diagnosed Atrial Fibrillation in Patients with Heart Failure

Sex Differences in the Association between Atrial Fibrillation and 90-Day Adverse Outcomes among Older Adults with Heart Failure: A Retrospective Cohort Study

Association of sleep duration and physical frailty with cognitive function in older patients with coexisting atrial fibrillation and heart failure

Contact Info

Product

Resources

About