Long-term impact of new-onset atrial fibrillation complicating acute myocardial infarction on heart failure: insights from the NOAFCAMI-SH registry
Abstract Background New-onset atrial fibrillation (NOAF) complicating acute myocardial infarction (AMI) has been associated with poor survival, but the clinical implication of NOAF on subsequent heart failure (HF) is still not well studied. We aimed to investigate the relationship between NOAF follo...
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| description | Abstract
Background
New-onset atrial fibrillation (NOAF) complicating acute myocardial infarction (AMI) has been associated with poor survival, but the clinical implication of NOAF on subsequent heart failure (HF) is still not well studied. We aimed to investigate the relationship between NOAF following AMI and HF hospitalization.
Methods
This retrospective cohort study was conducted between February 2014 and March 2018, using data from the New-Onset Atrial Fibrillation Complicating Acute Myocardial Infarction in ShangHai registry, where all participants did not have a documented AF history. Patients with AMI who discharged alive and had complete echocardiography and follow-up data were analyzed. The primary outcome was HF hospitalization, which was defined as a minimum of an overnight hospital stay of a participant who presented with symptoms and signs of HF or received intravenous diuretics.
Results
A total of 2075 patients were included, of whom 228 developed NOAF during the index AMI hospitalization. During up to 5 years of follow-up (median: 2.7 years), 205 patients (9.9%) experienced HF hospitalization and 220 patients (10.6%) died. The incidence rate of HF hospitalization among patients with NOAF was 18.4% per year compared with 2.8% per year for those with sinus rhythm. After adjustment for confounders, NOAF was significantly associated with HF hospitalization (hazard ratio [HR]: 3.14, 95% confidence interval [CI]: 2.30–4.28; p |
| doi_str_mv | 10.1093/ehjci/ehaa946.1750 |
| format | Article |
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Background
New-onset atrial fibrillation (NOAF) complicating acute myocardial infarction (AMI) has been associated with poor survival, but the clinical implication of NOAF on subsequent heart failure (HF) is still not well studied. We aimed to investigate the relationship between NOAF following AMI and HF hospitalization.
Methods
This retrospective cohort study was conducted between February 2014 and March 2018, using data from the New-Onset Atrial Fibrillation Complicating Acute Myocardial Infarction in ShangHai registry, where all participants did not have a documented AF history. Patients with AMI who discharged alive and had complete echocardiography and follow-up data were analyzed. The primary outcome was HF hospitalization, which was defined as a minimum of an overnight hospital stay of a participant who presented with symptoms and signs of HF or received intravenous diuretics.
Results
A total of 2075 patients were included, of whom 228 developed NOAF during the index AMI hospitalization. During up to 5 years of follow-up (median: 2.7 years), 205 patients (9.9%) experienced HF hospitalization and 220 patients (10.6%) died. The incidence rate of HF hospitalization among patients with NOAF was 18.4% per year compared with 2.8% per year for those with sinus rhythm. After adjustment for confounders, NOAF was significantly associated with HF hospitalization (hazard ratio [HR]: 3.14, 95% confidence interval [CI]: 2.30–4.28; p<0.001). Consistent result was observed after accounting for the competing risk of all-cause death (subdistribution HR: 3.06, 95% CI: 2.18–4.30; p<0.001) or performing a propensity score adjusted multivariable model (HR: 3.28, 95% CI: 2.39–4.50; p<0.001). Furthermore, the risk of HF hospitalization was significantly higher in patients with persistent NOAF (HR: 5.81; 95% CI: 3.59–9.41) compared with that in those with transient NOAF (HR: 2.61; 95% CI: 1.84–3.70; p interaction = 0.008).
Conclusion
NOAF complicating AMI is strongly associated with an increased long-term risk of heart.
Clinical outcomes
Clinical outcome
NOAF
Sinus rhythm
Unadjusted risk
Multivariable adjusted risk*
Events/Patients; %/Year
Events/Patients; %/Year
HR (95% CI)
HR (95% CI)
Heart failure
75/228; 18.4 (14.6–23.0)
130/1847; 2.8 (2.3–3.3)
5.81 (4.36–7.73), p<0.001
3.14 (2.30–4.28), p<0.001
All-cause death
62/228; 12.3 (9.6–15.8)
158/1847; 3.2 (2.8–3.8)
3.76 (2.80–5.05), p<0.001
1.90 (1.38–2.61), p<0.001
Cardiovascular death
47/228; 9.4 (7.0–12.5)
12/1847; 2.3 (1.9–2.7)
3.95 (2.81–5.55), p<0.001
1.97 (1.36–2.85), p<0.001
*Adjusted for age, sex, current smoking, hypertension, diabetes, hyperlipidemia, CKD, history of HF, previous MI, previous stroke/TIA, admission HF, admission heart rate, admission SBP, in-hospital PCI with stent, LVEF, and the medications at discharge (ACEI/ARB, statin, β-blocker, and diuretic).
Cumulative incidence of outcome
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): 1. National Natural Science Foundation of China, 2. Natural Science Foundation of Shanghai]]></description><identifier>ISSN: 0195-668X</identifier><identifier>EISSN: 1522-9645</identifier><identifier>DOI: 10.1093/ehjci/ehaa946.1750</identifier><language>eng</language><publisher>Oxford University Press</publisher><ispartof>European heart journal, 2020-11, Vol.41 (Supplement_2)</ispartof><rights>Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020. For permissions, please email: journals.permissions@oup.com. 2020</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids></links><search><creatorcontrib>Xu, S.L</creatorcontrib><creatorcontrib>Luo, J</creatorcontrib><creatorcontrib>Li, H.Q</creatorcontrib><creatorcontrib>Li, Z.Q</creatorcontrib><creatorcontrib>Liu, B.X</creatorcontrib><creatorcontrib>Qin, X.M</creatorcontrib><creatorcontrib>Gong, M.M</creatorcontrib><creatorcontrib>Shi, B.B</creatorcontrib><creatorcontrib>Wei, Y.D</creatorcontrib><title>Long-term impact of new-onset atrial fibrillation complicating acute myocardial infarction on heart failure: insights from the NOAFCAMI-SH registry</title><title>European heart journal</title><description><![CDATA[Abstract
Background
New-onset atrial fibrillation (NOAF) complicating acute myocardial infarction (AMI) has been associated with poor survival, but the clinical implication of NOAF on subsequent heart failure (HF) is still not well studied. We aimed to investigate the relationship between NOAF following AMI and HF hospitalization.
Methods
This retrospective cohort study was conducted between February 2014 and March 2018, using data from the New-Onset Atrial Fibrillation Complicating Acute Myocardial Infarction in ShangHai registry, where all participants did not have a documented AF history. Patients with AMI who discharged alive and had complete echocardiography and follow-up data were analyzed. The primary outcome was HF hospitalization, which was defined as a minimum of an overnight hospital stay of a participant who presented with symptoms and signs of HF or received intravenous diuretics.
Results
A total of 2075 patients were included, of whom 228 developed NOAF during the index AMI hospitalization. During up to 5 years of follow-up (median: 2.7 years), 205 patients (9.9%) experienced HF hospitalization and 220 patients (10.6%) died. The incidence rate of HF hospitalization among patients with NOAF was 18.4% per year compared with 2.8% per year for those with sinus rhythm. After adjustment for confounders, NOAF was significantly associated with HF hospitalization (hazard ratio [HR]: 3.14, 95% confidence interval [CI]: 2.30–4.28; p<0.001). Consistent result was observed after accounting for the competing risk of all-cause death (subdistribution HR: 3.06, 95% CI: 2.18–4.30; p<0.001) or performing a propensity score adjusted multivariable model (HR: 3.28, 95% CI: 2.39–4.50; p<0.001). Furthermore, the risk of HF hospitalization was significantly higher in patients with persistent NOAF (HR: 5.81; 95% CI: 3.59–9.41) compared with that in those with transient NOAF (HR: 2.61; 95% CI: 1.84–3.70; p interaction = 0.008).
Conclusion
NOAF complicating AMI is strongly associated with an increased long-term risk of heart.
Clinical outcomes
Clinical outcome
NOAF
Sinus rhythm
Unadjusted risk
Multivariable adjusted risk*
Events/Patients; %/Year
Events/Patients; %/Year
HR (95% CI)
HR (95% CI)
Heart failure
75/228; 18.4 (14.6–23.0)
130/1847; 2.8 (2.3–3.3)
5.81 (4.36–7.73), p<0.001
3.14 (2.30–4.28), p<0.001
All-cause death
62/228; 12.3 (9.6–15.8)
158/1847; 3.2 (2.8–3.8)
3.76 (2.80–5.05), p<0.001
1.90 (1.38–2.61), p<0.001
Cardiovascular death
47/228; 9.4 (7.0–12.5)
12/1847; 2.3 (1.9–2.7)
3.95 (2.81–5.55), p<0.001
1.97 (1.36–2.85), p<0.001
*Adjusted for age, sex, current smoking, hypertension, diabetes, hyperlipidemia, CKD, history of HF, previous MI, previous stroke/TIA, admission HF, admission heart rate, admission SBP, in-hospital PCI with stent, LVEF, and the medications at discharge (ACEI/ARB, statin, β-blocker, and diuretic).
Cumulative incidence of outcome
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): 1. National Natural Science Foundation of China, 2. Natural Science Foundation of Shanghai]]></description><issn>0195-668X</issn><issn>1522-9645</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><recordid>eNqNkE1OwzAQhS0EEqVwAVa-gIudxI7NrqoorVTogi7YRbZrp66SOLJdoZ6DC5P-HABpNKM3894sPgCeCZ4QLPIXs9trN3QpRcEmpKT4BowIzTIkWEFvwQgTQRFj_PsePMS4xxhzRtgI_K58V6NkQgtd20udoLewMz_Id9EkKFNwsoHWqeCaRibnO6h92zdOD6KrodSHZGB79FqG7cnqOiuDPhuH2hkZErTSNYdgXodjdPUuRWiDb2HaGfi5ns5n048l-lrAYGoXUzg-gjsrm2iernMMNvO3zWyBVuv35Wy6QpoTjKhQWkhO6TZThHNjrckx54pkFjOFpcgpVkqZEsvCcG11VhAljCqHDRNZmY9Bdnmrg48xGFv1wbUyHCuCqxPV6ky1ulKtTlSHELqE_KH_j_8PinB_1g</recordid><startdate>20201101</startdate><enddate>20201101</enddate><creator>Xu, S.L</creator><creator>Luo, J</creator><creator>Li, H.Q</creator><creator>Li, Z.Q</creator><creator>Liu, B.X</creator><creator>Qin, X.M</creator><creator>Gong, M.M</creator><creator>Shi, B.B</creator><creator>Wei, Y.D</creator><general>Oxford University Press</general><scope>AAYXX</scope><scope>CITATION</scope></search><sort><creationdate>20201101</creationdate><title>Long-term impact of new-onset atrial fibrillation complicating acute myocardial infarction on heart failure: insights from the NOAFCAMI-SH registry</title><author>Xu, S.L ; Luo, J ; Li, H.Q ; Li, Z.Q ; Liu, B.X ; Qin, X.M ; Gong, M.M ; Shi, B.B ; Wei, Y.D</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c810-59bc9a855d2b188effe3088b12f06b0a9350bbbe70a4e8cfc241b9eb7e7069273</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Xu, S.L</creatorcontrib><creatorcontrib>Luo, J</creatorcontrib><creatorcontrib>Li, H.Q</creatorcontrib><creatorcontrib>Li, Z.Q</creatorcontrib><creatorcontrib>Liu, B.X</creatorcontrib><creatorcontrib>Qin, X.M</creatorcontrib><creatorcontrib>Gong, M.M</creatorcontrib><creatorcontrib>Shi, B.B</creatorcontrib><creatorcontrib>Wei, Y.D</creatorcontrib><collection>CrossRef</collection><jtitle>European heart journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Xu, S.L</au><au>Luo, J</au><au>Li, H.Q</au><au>Li, Z.Q</au><au>Liu, B.X</au><au>Qin, X.M</au><au>Gong, M.M</au><au>Shi, B.B</au><au>Wei, Y.D</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Long-term impact of new-onset atrial fibrillation complicating acute myocardial infarction on heart failure: insights from the NOAFCAMI-SH registry</atitle><jtitle>European heart journal</jtitle><date>2020-11-01</date><risdate>2020</risdate><volume>41</volume><issue>Supplement_2</issue><issn>0195-668X</issn><eissn>1522-9645</eissn><abstract><![CDATA[Abstract
Background
New-onset atrial fibrillation (NOAF) complicating acute myocardial infarction (AMI) has been associated with poor survival, but the clinical implication of NOAF on subsequent heart failure (HF) is still not well studied. We aimed to investigate the relationship between NOAF following AMI and HF hospitalization.
Methods
This retrospective cohort study was conducted between February 2014 and March 2018, using data from the New-Onset Atrial Fibrillation Complicating Acute Myocardial Infarction in ShangHai registry, where all participants did not have a documented AF history. Patients with AMI who discharged alive and had complete echocardiography and follow-up data were analyzed. The primary outcome was HF hospitalization, which was defined as a minimum of an overnight hospital stay of a participant who presented with symptoms and signs of HF or received intravenous diuretics.
Results
A total of 2075 patients were included, of whom 228 developed NOAF during the index AMI hospitalization. During up to 5 years of follow-up (median: 2.7 years), 205 patients (9.9%) experienced HF hospitalization and 220 patients (10.6%) died. The incidence rate of HF hospitalization among patients with NOAF was 18.4% per year compared with 2.8% per year for those with sinus rhythm. After adjustment for confounders, NOAF was significantly associated with HF hospitalization (hazard ratio [HR]: 3.14, 95% confidence interval [CI]: 2.30–4.28; p<0.001). Consistent result was observed after accounting for the competing risk of all-cause death (subdistribution HR: 3.06, 95% CI: 2.18–4.30; p<0.001) or performing a propensity score adjusted multivariable model (HR: 3.28, 95% CI: 2.39–4.50; p<0.001). Furthermore, the risk of HF hospitalization was significantly higher in patients with persistent NOAF (HR: 5.81; 95% CI: 3.59–9.41) compared with that in those with transient NOAF (HR: 2.61; 95% CI: 1.84–3.70; p interaction = 0.008).
Conclusion
NOAF complicating AMI is strongly associated with an increased long-term risk of heart.
Clinical outcomes
Clinical outcome
NOAF
Sinus rhythm
Unadjusted risk
Multivariable adjusted risk*
Events/Patients; %/Year
Events/Patients; %/Year
HR (95% CI)
HR (95% CI)
Heart failure
75/228; 18.4 (14.6–23.0)
130/1847; 2.8 (2.3–3.3)
5.81 (4.36–7.73), p<0.001
3.14 (2.30–4.28), p<0.001
All-cause death
62/228; 12.3 (9.6–15.8)
158/1847; 3.2 (2.8–3.8)
3.76 (2.80–5.05), p<0.001
1.90 (1.38–2.61), p<0.001
Cardiovascular death
47/228; 9.4 (7.0–12.5)
12/1847; 2.3 (1.9–2.7)
3.95 (2.81–5.55), p<0.001
1.97 (1.36–2.85), p<0.001
*Adjusted for age, sex, current smoking, hypertension, diabetes, hyperlipidemia, CKD, history of HF, previous MI, previous stroke/TIA, admission HF, admission heart rate, admission SBP, in-hospital PCI with stent, LVEF, and the medications at discharge (ACEI/ARB, statin, β-blocker, and diuretic).
Cumulative incidence of outcome
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): 1. National Natural Science Foundation of China, 2. Natural Science Foundation of Shanghai]]></abstract><pub>Oxford University Press</pub><doi>10.1093/ehjci/ehaa946.1750</doi></addata></record> |
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| title | Long-term impact of new-onset atrial fibrillation complicating acute myocardial infarction on heart failure: insights from the NOAFCAMI-SH registry |
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