The prognostic interplay of heart failure and chronic kidney disease in atrial fibrillation, focus on cardiorenal outcomes

Abstract Background Heart failure (HF) and chronic kidney disease (CKD) create a mutually reinforcing cycle, escalating disease development, and increasing morbidity and mortality rates. Both are common comorbidities promoting atrial fibrillation (AF) and contributing to heightened symptom burden and poorer outcomes in AF. Purpose To investigate the relationship of HF and CKD with cardiorenal outcomes in patients with AF. Methods For this analysis we included patients with known AF, treated at a tertiary centre between 01/2005 and 07/2019. The primary endpoint was a composite of cardiovascular (CV) death and hospitalization for HF (HHF). Secondary outcomes were renal death and dialysis. The multivariate model has been adjusted for age, sex, body mass index, HF, diabetes mellitus, CKD, coronary artery disease, previous myocardial infarction, and C-reactive protein. Results We included in total 7412 patients (median age 70 years, 39.7% female) with AF and followed them over a median of 4.5 years. A total of 1668 patients (22.5%) were diagnosed with HF, 806 (10.9%) with CKD and 372 (5.0%) were suffering from both conditions. Both CKD (adjusted HR 1.87, 95% CI 1.55-2.25) and HF (adjusted HR 2.57, 95% CI 2.22-2.98) were significantly associated with the composite of CV death/ HHF after multivariable adjustment. There was a significant stepwise increase in 5-year’s event rates of CV death/ HHF (no CKD & no HF: 23%, HF: 61%, CKD: 63%, CKD & HF: 82%; P-logrank