Mortality and heart failure in patients with a history of atrial fibrillation undergoing mitral valve surgery

Abstract Background A history of atrial fibrillation (AF) is frequently seen in patients with mitral regurgitation. However, the impact of AF on heart failure (HF) and mortality following mitral valve repair/replacement for mitral regurgitation remains unclear. Purpose To examine the long-term risk of HF admission and mortality in patients undergoing mitral valve repair/replacement with or without AF. Methods We included adult patients undergoing mitral valve repair/replace for mitral regurgitation in Denmark (2000-2018). Patients were categorized according to a history of AF. We examined the cumulative incidences of HF admission and all-cause mortality with a maximum of three years of follow-up. Here we used Kaplan-Meier and Cumulative Incidence Function curves accounting for competing risk of death. Likewise, groups were compared using Cox proportional hazards in adjusted analyses. Results We included 4480 patients where 1685 (37.6%) patients had a history of AF (median age: 70, 66.1% males) and 2795 (62.4%) patients had no history of AF (median age: 64, 67.6% males). Patients with a history of AF had a higher proportion of chronic HF (42.0% vs 23.5%), ischaemic heart disease (37.4% vs 29.4%), and stroke (7.7% vs. 4.3%) at baseline. Patients with a history of AF before surgery admission were less likely to undergo mitral valve repair (65% vs. 72%). The cumulative three-year incidence of HF-admission was 23.7% in patients with a history of AF and 14.6% in patients without a history of AF (Figure A). Adjusted analysis found a statistically significant increased rate of HF admissions (HR=1.19 [95% CI 1.02-1.39]). The cumulative three-year incidence of mortality was 13.8% in patients with a history of AF, and 8.2% in patients without a history AF (Figure B). Adjusted analysis yielded no statistically significant difference in the associated rate of mortality (HR=1.16 [95% CI 0.95-1.43]). Factors associated with both increased HF admission and mortality were among others age, myocardial infarction, and known chronic HF. Conclusion One in three patients had a history of atrial fibrillation, and these patients were associated with an increased rate of both heart failure admission and mortality, but following adjustments the association was only statistically significant for heart failure admission.Cumulative incidence of HF-admissionCumulative incidence of mortality