Heart Failure in Patients With Atrial Fibrillation Is Associated With a High Symptom and Hospitalization Burden: The RealiseAF Survey

Abstract

Background: Atrial fibrillation (AF) and heart failure (HF) often coexist; the consequences of such coexistence are unclear. Hypothesis: HF in patients with AF is associated with poor outcomes. Methods: This post hoc analysis of RealiseAF, a survey of AF patients, compared symptoms, hospitalizations, management, and AF control in patients with vs without HF. A total of 10,523 AF patients were analyzed according to presence/absence of HF. Results: History of HF was present in 45.8%, and in more patients with permanent vs persistent, paroxysmal, or first-episode AF (55.6%, 44.3%, 32.9%, and 29.8%, respectively; P < 0.0001). Patients with vs those without history of HF, and patients with HF and reduced ejection fraction (HF-REF) vs those with HF and a preserved ejection fraction (HF-PEF), had more frequent cardiovascular (CV) risk factors and more severe symptoms. Presence vs absence of HF, and HF-REF vs HF-PEF, were associated with lower rates of AF control (54.6% vs 62.8% and 49.3% vs 60.3%, respectively; both P < 0.0001). The rate-control strategy was used more frequently in HF patients, particularly those with HF-REF, than the rhythm-control strategy. CV hospitalizations occurred more frequently in patients with HF than those without (41.8% vs 17.5%; P < 0.001) and more frequently in patients with HF-REF than in those with HF-PEF (51.6% vs 35.6%; P < 0.0001). Conclusions: AF patients with HF, particularly HF-REF, experience heavy symptom and hospitalization burdens, and have relatively low rates of AF control. Further studies are needed to identify ways to improve the management and treatment outcomes of this very high-risk patient population.

Multimorbidity and the risk of hospitalization and death in atrial fibrillation: A population-based study

“…Heart failure is a common comorbid condition among patients with AF and increases the risk of all-cause 17, 18 and cardiovascular-related 15, 17, 33 hospitalization in AF patients. In addition to heart failure, myocardial infarction and chronic obstructive pulmonary disease were the strongest predictors of cardiovascular-related hospitalization in the MarketScan and Geisinger Health Systems databases.…”

Calcium in the Pathophysiology of Atrial Fibrillation and Heart Failure

“…Heart failure occurs in up to one third of patients with AF (Santhanakrishnan et al, 2016 ), which may be as a direct result of rapid ventricular rates in AF [known as a tachycardia-induced cardiomyopathy (Fujino et al, 2007 )] or the association of risk factors common to both conditions such as hypertension (Benjamin et al, 1994 ; Levy et al, 1996 ). If heart failure occurs in those with AF, the patient is likely to face an increased burden of symptoms, more admissions to hospital and a lower chance of restoring sinus rhythm (Silva-Cardoso et al, 2013 ; Odutayo et al, 2017 ). On the other hand, in those who initially have a normal cardiac rhythm, heart failure is associated with a 5-fold increase in the risk of developing new AF (Benjamin et al, 1994 ) due to electrical and structural remodeling in the atria (Nattel et al, 2007 ; Nattel and Harada, 2014 ), which can also increase rates of hospitalization, stroke, and death (Dries et al, 1998 ; McManus et al, 2013 ; Odutayo et al, 2017 ).…”

The Influence of Atrial Fibrillation on Cardiac Resynchronization Therapy

“…AF patients may have left ventricular dysfunction due to inappropriate increase in heart rate, loss of atrial contraction, irregularity of the heart beat intervals, or due to low cardiac output related to tachycardia-induced cardiomyopathy. [58][59][60][61] Since these deleterious effects on cardiac function may be reversible, it is of most importance to terminate atrial fibrillation and maintain sinus rhythm in these already compromised HF patients. In this context, it is very interesting the findings of several studies.…”