Prognostic Significance of New-Onset Atrial Fibrillation in Heart Failure with Preserved, Mid-Range, and Reduced Ejection Fraction Following Acute Myocardial Infarction: Data from the NOAFCAMI-SH Registry

Abstract

Purpose The prognostic impact of new-onset atrial fibrillation (NOAF) among different heart failure (HF) subtypes including HF with preserved (HFpEF, ejection fraction [EF] ≥50%), mid-range (HFmrEF, EF 40%~49%), and reduced (HFrEF, EF <40%) EF following acute myocardial infarction (AMI) remains unclear. We aimed to investigate the incidence and prognostic implication of post-MI NOAF across HF subtypes. Patients and Methods We included 1413 patients with post-MI HF (743 with HFpEF, 342 with HFmrEF and 328 with HFrEF) between February 2014 and March 2018. NOAF was considered as patients without a preexisting AF who developed AF during the AMI hospitalization. The primary endpoint was all-cause mortality. Results Of 1413 patients (mean age 66.8 ± 12.6 years, 72.9% men) analyzed, 200 (14.2%) developed post-MI NOAF. Patients with HFrEF were more likely to experience NOAF compared to those with HFmrEF or HFrEF (18.9%, 13.7% and 12.2% in HFrEF, HFmrEF and HFpEF, respectively; p for trend = 0.006). During a median follow-up of 28.5 months, 192 patients died (70 with HFrEF, 35 with HFmrEF and 87 with HFpEF) and 195 patients experienced HF rehospitalization (79 with HFrEF, 37 with HFmrEF and 79 with HFpEF). After multivariable adjustment, NOAF was independently associated with all-cause mortality (hazard ratio [HR]: 1.79, 95% confidence interval [CI]: 1.03–3.12) only in the HFrEF group compared to sinus rhythm (SR), whereas an increased risk of HF rehospitalization was found in all HF subtypes, particularly in HFmrEF (HR: 5.08, 95% CI: 2.29–11.25) and HFpEF (HR: 2.83 95% CI: 1.64–4.90). Conclusion In patients with post-MI HF, NOAF carried a worse prognosis for all-cause death in the HFrEF group and for HF rehospitalization in all HF subtypes.

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

“…A total of 7467 citations were identified from the initial PubMed, EMBASE, Cochrane Library. Following application of inclusion criteria, exclusion criteria, and quality assessment, 22 studies 16,26–46 with 248 323 patients were retained for the systematic review and meta‐analysis comparing AF prevalence and its impact of all‐cause mortality, HF hospitalization, CV, and stroke/TIA between HFrEF, HFmrEF, and HFpEF categories. Of these, 123 331 were HFrEF patients (49.7%); 40 995 HFmrEF (16.5%); and 83 997 HFpEF (33.8%).…”

“…A total of eight studies 16,29,35,36,38,[43][44][45] were included in the metaanalysis of AF versus no AF and all-cause mortality outcome. The pooled HR (95% CI) of all-cause mortality associated with AF using random effect DerSimonian-Laird model for the total population was 1.13 (1.07-1.21), p < .001.…”

“…Five studies 35,36,42,44,45 assessed the impact of AF on HF hospitalization across categories of HF based on LVEF. In the total population combining all three HF phenotypes, the presence of AF was significantly associated with of HF hospitalization: pooled HR (95% CI) 1.29 (1.14−1.46), p < .001.…”

Prognosis in patients with cardiorenal syndrome depending on the clinical form of atrial fibrillation

“…Влияние ФП на развитие новых сердечно-сосудистых событий у пациентов с ХСН общеизвестно. В наибольшей степени неблагоприятное влияние ФП в отношении прогноза актуально у больных ХСН с низкой ФВ ЛЖ [9]. Установлено, что нейрогуморальные механизмы, активированные выраженной сократительной дисфункцией миокарда, оказывают негативное воздействие на формирование предсердного ремоделирования, фиброза и последующей аритмогенной готовности Сердечно-сосудистые заболевания / Cardiovascular medicine [10]…”

Coronavirus Disease 2019 Associated Acute Myocardial Infarction and Atrial Fibrillation: A Case Report

“…New-onset atrial fibrillation has been associated with worsening clinical outcomes in COVID-19 patients [ 9 ]. It is a life-threatening complication that is associated with a two-fold increase in mortality and a three-fold increase in secondary outcomes.…”