Effect of Atrial Fibrillation on Mortality, Stroke Risk, and Quality of Life Scores in Patients with Heart Failure (From the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation [ORBIT-AF])

Abstract The degree to which clinical outcomes are worsened in AF patients with HF compared to those without HF is not well described. This study aimed to determine the impact of heart failure (HF) on clinical outcomes in patients with atrial fibrillation (AF). We analyzed data from ORBIT-AF, a national registry of 10,135 AF patients to determine associations between HF as well as left ventricular ejection fraction (LVEF) and outcomes, including stroke, mortality, and hospitalization using Cox multivariable modeling. Atrial Fibrillation Effect on QualiTy-of-life (AFEQT) scores between groups were also compared. Overall, 33% (n=3203) of patients had HF; of these 33% (n=985) had LVEF ≤40%. Oral anticoagulation was prescribed more commonly in HF patients (81% vs 74%). Compared to patients without HF, HF patients had similar rate of stroke (1.28 vs. 0.88 per 100-patient years, HR 1.11, CI 0.83-1.48, p=0.47) but higher mortality (HR 1.69, CI 1.49-1.92, p < 0.001) and hospitalization (HR 1.31, CI 1.23-1.39, p < 0.0001). Patients with LVEF ≤40% had similar stroke risk (HR 1.06, CI 0.67-1.67) but higher mortality (HR 2.06, CI 1.74-2.44) and hospitalization (HR 1.38, CI 1.25-1.51). AFEQT Overall Score was significantly lower (76.9 v. 83.3, p < 0.0001) in HF patients. In conclusion, HF was associated with increased risk of death and hospitalization and worse quality of life, but similar rates of thromboembolism regardless of LVEF among patients with AF. These findings highlight the need to develop therapeutic strategies targeting functional status and survival for patients with HF and AF.