Outcomes of incident atrial fibrillation in heart failure with preserved or reduced ejection fraction: A community‐based study
Introduction The best management strategy for patients with atrial fibrillation (AF) with heart failure (HF) and preserved left ventricular ejection fraction (LVEF) is unknown. Methods and Results This cohort study was conducted in Olmsted County, Minnesota, with resources of the Rochester Epidemiol...
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| Veröffentlicht in: | Journal of cardiovascular electrophysiology 2020-09, Vol.31 (9), p.2275-2283 |
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| container_title | Journal of cardiovascular electrophysiology |
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| creator | Zhang, Pei Chamberlain, Alanna M. Hodge, David O. Cai, Cheng Xiao, Pei L. Han, Jie Jiang, Chen‐Yang Redfield, Margaret M. Roger, Veronique L. Cha, Yong‐Mei |
| description | Introduction
The best management strategy for patients with atrial fibrillation (AF) with heart failure (HF) and preserved left ventricular ejection fraction (LVEF) is unknown.
Methods and Results
This cohort study was conducted in Olmsted County, Minnesota, with resources of the Rochester Epidemiology Project. Patients with incident AF occurring between 2000 and 2014 with a prior or concurrent HF were included. Patients with LVEF ≥ 50% were designated as HF and preserved ejection fraction (HFpEF) and those with LVEF |
| doi_str_mv | 10.1111/jce.14632 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8562322</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2417396021</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4432-32a06a72fdb4a9587897cce04ec13c6f2d40c5fb49f75821ad7cdf327081b2183</originalsourceid><addsrcrecordid>eNp1kctuFDEQRVsIREJgwQ8gS2xg0Ylf3XazQIpG4aVI2cDacttlxqPu9uBHotnlE_hGvgQzEyJAwhtfqY5vVfk2zXOCT0k9ZxsDp4T3jD5ojknHcStJLx5WjXnXMinYUfMkpQ3GhPW4e9wcMdpJzgd53NxelWzCDAkFh_xivIUlI52j1xNyfox-mnT2YalFtAYdM3LaTyUCuvF5jbYREsRrsChEFMEWUyVswOzfuKj34g06R7XLXBafdz9uv486VSzlYndPm0dOTwme3d0nzZd3F59XH9rLq_cfV-eXreGc0ZZRjXstqLMj10MnhRyEMYA5GMJM76jl2HRu5IMTnaREW2GsY1RgSUZKJDtp3h58t2WcwZq6ZtST2kY_67hTQXv1d2Xxa_U1XCvZ9ZRRWg1e3RnE8K1Aymr2yUD9ngVCSYpyItjQY0oq-vIfdBNKXOp6leKYyg4LXqnXB8rEkFIEdz8MwepXrqrmqva5VvbFn9Pfk7-DrMDZAbjxE-z-76Q-rS4Olj8BlRWwCw</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2440285074</pqid></control><display><type>article</type><title>Outcomes of incident atrial fibrillation in heart failure with preserved or reduced ejection fraction: A community‐based study</title><source>MEDLINE</source><source>Wiley Journals</source><creator>Zhang, Pei ; Chamberlain, Alanna M. ; Hodge, David O. ; Cai, Cheng ; Xiao, Pei L. ; Han, Jie ; Jiang, Chen‐Yang ; Redfield, Margaret M. ; Roger, Veronique L. ; Cha, Yong‐Mei</creator><creatorcontrib>Zhang, Pei ; Chamberlain, Alanna M. ; Hodge, David O. ; Cai, Cheng ; Xiao, Pei L. ; Han, Jie ; Jiang, Chen‐Yang ; Redfield, Margaret M. ; Roger, Veronique L. ; Cha, Yong‐Mei</creatorcontrib><description>Introduction
The best management strategy for patients with atrial fibrillation (AF) with heart failure (HF) and preserved left ventricular ejection fraction (LVEF) is unknown.
Methods and Results
This cohort study was conducted in Olmsted County, Minnesota, with resources of the Rochester Epidemiology Project. Patients with incident AF occurring between 2000 and 2014 with a prior or concurrent HF were included. Patients with LVEF ≥ 50% were designated as HF and preserved ejection fraction (HFpEF) and those with LVEF < 50% were designated as HF and reduced ejection fraction (HFrEF). Rhythm control in the first year after AF diagnosis was defined as prescriptions for an antiarrhythmic drug, catheter ablation, or maze procedure. The primary endpoint was all‐cause mortality. The secondary endpoints were cardiovascular death, cardiovascular hospitalization, and stroke or transient ischemic attack. Of 859 patients (age, 77.2 ± 12.1 years; 49.2%, female), 447 had HFpEF‐AF, and 412 had HFrEF‐AF. There was no difference in all‐cause mortality (10‐year mortality, 83% vs 79%; p = .54) or secondary endpoints between the HFpEF‐AF and HFrEF‐AF, respectively. Compared with the rate control strategy, rhythm control in HFpEF‐AF patients (n = 40, 15.9%) offered no survival benefits (adjusted HR, 0.70; 95% CI, 0.42–1.16; p = .16), whereas rhythm control in HFrEF‐AF patients (n = 52, 22.5%) decrease cardiovascular mortality (HR, 0.38; 95% CI, 0.17–0.86; p = .02).
Conclusions
Patients with HFpEF‐AF and HFrEF‐AF had similar poor prognoses. Rhythm control strategy was seldom adopted in community care in patients with HF and AF. A rhythm control strategy may provide survival benefit for patients with HFrEF‐AF and the benefit of rhythm control in patients with HFpEF‐AF warrants further study.</description><identifier>ISSN: 1045-3873</identifier><identifier>ISSN: 1540-8167</identifier><identifier>EISSN: 1540-8167</identifier><identifier>DOI: 10.1111/jce.14632</identifier><identifier>PMID: 32584498</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Aged ; Aged, 80 and over ; atrial fibrillation ; Atrial Fibrillation - diagnosis ; Atrial Fibrillation - epidemiology ; Atrial Fibrillation - therapy ; Cardiac arrhythmia ; Cardiovascular diseases ; Catheters ; Cohort Studies ; Congestive heart failure ; Ejection fraction ; Epidemiology ; Female ; Fibrillation ; Heart failure ; Heart Failure - diagnosis ; Heart Failure - epidemiology ; Heart Failure - therapy ; heart failure with preserved ejection fraction ; heart failure with reduced ejection fraction ; Humans ; Ischemia ; Male ; Minnesota - epidemiology ; Mortality ; Prognosis ; rate control ; rhythm control ; Stroke Volume ; Survival ; Transient ischemic attack ; Ventricle ; Ventricular Function, Left</subject><ispartof>Journal of cardiovascular electrophysiology, 2020-09, Vol.31 (9), p.2275-2283</ispartof><rights>2020 Wiley Periodicals LLC</rights><rights>2020 Wiley Periodicals LLC.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4432-32a06a72fdb4a9587897cce04ec13c6f2d40c5fb49f75821ad7cdf327081b2183</citedby><cites>FETCH-LOGICAL-c4432-32a06a72fdb4a9587897cce04ec13c6f2d40c5fb49f75821ad7cdf327081b2183</cites><orcidid>0000-0002-9986-0654 ; 0000-0002-5897-9464</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fjce.14632$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fjce.14632$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>230,314,776,780,881,1411,27903,27904,45553,45554</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32584498$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Zhang, Pei</creatorcontrib><creatorcontrib>Chamberlain, Alanna M.</creatorcontrib><creatorcontrib>Hodge, David O.</creatorcontrib><creatorcontrib>Cai, Cheng</creatorcontrib><creatorcontrib>Xiao, Pei L.</creatorcontrib><creatorcontrib>Han, Jie</creatorcontrib><creatorcontrib>Jiang, Chen‐Yang</creatorcontrib><creatorcontrib>Redfield, Margaret M.</creatorcontrib><creatorcontrib>Roger, Veronique L.</creatorcontrib><creatorcontrib>Cha, Yong‐Mei</creatorcontrib><title>Outcomes of incident atrial fibrillation in heart failure with preserved or reduced ejection fraction: A community‐based study</title><title>Journal of cardiovascular electrophysiology</title><addtitle>J Cardiovasc Electrophysiol</addtitle><description>Introduction
The best management strategy for patients with atrial fibrillation (AF) with heart failure (HF) and preserved left ventricular ejection fraction (LVEF) is unknown.
Methods and Results
This cohort study was conducted in Olmsted County, Minnesota, with resources of the Rochester Epidemiology Project. Patients with incident AF occurring between 2000 and 2014 with a prior or concurrent HF were included. Patients with LVEF ≥ 50% were designated as HF and preserved ejection fraction (HFpEF) and those with LVEF < 50% were designated as HF and reduced ejection fraction (HFrEF). Rhythm control in the first year after AF diagnosis was defined as prescriptions for an antiarrhythmic drug, catheter ablation, or maze procedure. The primary endpoint was all‐cause mortality. The secondary endpoints were cardiovascular death, cardiovascular hospitalization, and stroke or transient ischemic attack. Of 859 patients (age, 77.2 ± 12.1 years; 49.2%, female), 447 had HFpEF‐AF, and 412 had HFrEF‐AF. There was no difference in all‐cause mortality (10‐year mortality, 83% vs 79%; p = .54) or secondary endpoints between the HFpEF‐AF and HFrEF‐AF, respectively. Compared with the rate control strategy, rhythm control in HFpEF‐AF patients (n = 40, 15.9%) offered no survival benefits (adjusted HR, 0.70; 95% CI, 0.42–1.16; p = .16), whereas rhythm control in HFrEF‐AF patients (n = 52, 22.5%) decrease cardiovascular mortality (HR, 0.38; 95% CI, 0.17–0.86; p = .02).
Conclusions
Patients with HFpEF‐AF and HFrEF‐AF had similar poor prognoses. Rhythm control strategy was seldom adopted in community care in patients with HF and AF. A rhythm control strategy may provide survival benefit for patients with HFrEF‐AF and the benefit of rhythm control in patients with HFpEF‐AF warrants further study.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>atrial fibrillation</subject><subject>Atrial Fibrillation - diagnosis</subject><subject>Atrial Fibrillation - epidemiology</subject><subject>Atrial Fibrillation - therapy</subject><subject>Cardiac arrhythmia</subject><subject>Cardiovascular diseases</subject><subject>Catheters</subject><subject>Cohort Studies</subject><subject>Congestive heart failure</subject><subject>Ejection fraction</subject><subject>Epidemiology</subject><subject>Female</subject><subject>Fibrillation</subject><subject>Heart failure</subject><subject>Heart Failure - diagnosis</subject><subject>Heart Failure - epidemiology</subject><subject>Heart Failure - therapy</subject><subject>heart failure with preserved ejection fraction</subject><subject>heart failure with reduced ejection fraction</subject><subject>Humans</subject><subject>Ischemia</subject><subject>Male</subject><subject>Minnesota - epidemiology</subject><subject>Mortality</subject><subject>Prognosis</subject><subject>rate control</subject><subject>rhythm control</subject><subject>Stroke Volume</subject><subject>Survival</subject><subject>Transient ischemic attack</subject><subject>Ventricle</subject><subject>Ventricular Function, Left</subject><issn>1045-3873</issn><issn>1540-8167</issn><issn>1540-8167</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kctuFDEQRVsIREJgwQ8gS2xg0Ylf3XazQIpG4aVI2cDacttlxqPu9uBHotnlE_hGvgQzEyJAwhtfqY5vVfk2zXOCT0k9ZxsDp4T3jD5ojknHcStJLx5WjXnXMinYUfMkpQ3GhPW4e9wcMdpJzgd53NxelWzCDAkFh_xivIUlI52j1xNyfox-mnT2YalFtAYdM3LaTyUCuvF5jbYREsRrsChEFMEWUyVswOzfuKj34g06R7XLXBafdz9uv486VSzlYndPm0dOTwme3d0nzZd3F59XH9rLq_cfV-eXreGc0ZZRjXstqLMj10MnhRyEMYA5GMJM76jl2HRu5IMTnaREW2GsY1RgSUZKJDtp3h58t2WcwZq6ZtST2kY_67hTQXv1d2Xxa_U1XCvZ9ZRRWg1e3RnE8K1Aymr2yUD9ngVCSYpyItjQY0oq-vIfdBNKXOp6leKYyg4LXqnXB8rEkFIEdz8MwepXrqrmqva5VvbFn9Pfk7-DrMDZAbjxE-z-76Q-rS4Olj8BlRWwCw</recordid><startdate>202009</startdate><enddate>202009</enddate><creator>Zhang, Pei</creator><creator>Chamberlain, Alanna M.</creator><creator>Hodge, David O.</creator><creator>Cai, Cheng</creator><creator>Xiao, Pei L.</creator><creator>Han, Jie</creator><creator>Jiang, Chen‐Yang</creator><creator>Redfield, Margaret M.</creator><creator>Roger, Veronique L.</creator><creator>Cha, Yong‐Mei</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>K9.</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-9986-0654</orcidid><orcidid>https://orcid.org/0000-0002-5897-9464</orcidid></search><sort><creationdate>202009</creationdate><title>Outcomes of incident atrial fibrillation in heart failure with preserved or reduced ejection fraction: A community‐based study</title><author>Zhang, Pei ; Chamberlain, Alanna M. ; Hodge, David O. ; Cai, Cheng ; Xiao, Pei L. ; Han, Jie ; Jiang, Chen‐Yang ; Redfield, Margaret M. ; Roger, Veronique L. ; Cha, Yong‐Mei</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4432-32a06a72fdb4a9587897cce04ec13c6f2d40c5fb49f75821ad7cdf327081b2183</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>atrial fibrillation</topic><topic>Atrial Fibrillation - diagnosis</topic><topic>Atrial Fibrillation - epidemiology</topic><topic>Atrial Fibrillation - therapy</topic><topic>Cardiac arrhythmia</topic><topic>Cardiovascular diseases</topic><topic>Catheters</topic><topic>Cohort Studies</topic><topic>Congestive heart failure</topic><topic>Ejection fraction</topic><topic>Epidemiology</topic><topic>Female</topic><topic>Fibrillation</topic><topic>Heart failure</topic><topic>Heart Failure - diagnosis</topic><topic>Heart Failure - epidemiology</topic><topic>Heart Failure - therapy</topic><topic>heart failure with preserved ejection fraction</topic><topic>heart failure with reduced ejection fraction</topic><topic>Humans</topic><topic>Ischemia</topic><topic>Male</topic><topic>Minnesota - epidemiology</topic><topic>Mortality</topic><topic>Prognosis</topic><topic>rate control</topic><topic>rhythm control</topic><topic>Stroke Volume</topic><topic>Survival</topic><topic>Transient ischemic attack</topic><topic>Ventricle</topic><topic>Ventricular Function, Left</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Zhang, Pei</creatorcontrib><creatorcontrib>Chamberlain, Alanna M.</creatorcontrib><creatorcontrib>Hodge, David O.</creatorcontrib><creatorcontrib>Cai, Cheng</creatorcontrib><creatorcontrib>Xiao, Pei L.</creatorcontrib><creatorcontrib>Han, Jie</creatorcontrib><creatorcontrib>Jiang, Chen‐Yang</creatorcontrib><creatorcontrib>Redfield, Margaret M.</creatorcontrib><creatorcontrib>Roger, Veronique L.</creatorcontrib><creatorcontrib>Cha, Yong‐Mei</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of cardiovascular electrophysiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Zhang, Pei</au><au>Chamberlain, Alanna M.</au><au>Hodge, David O.</au><au>Cai, Cheng</au><au>Xiao, Pei L.</au><au>Han, Jie</au><au>Jiang, Chen‐Yang</au><au>Redfield, Margaret M.</au><au>Roger, Veronique L.</au><au>Cha, Yong‐Mei</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Outcomes of incident atrial fibrillation in heart failure with preserved or reduced ejection fraction: A community‐based study</atitle><jtitle>Journal of cardiovascular electrophysiology</jtitle><addtitle>J Cardiovasc Electrophysiol</addtitle><date>2020-09</date><risdate>2020</risdate><volume>31</volume><issue>9</issue><spage>2275</spage><epage>2283</epage><pages>2275-2283</pages><issn>1045-3873</issn><issn>1540-8167</issn><eissn>1540-8167</eissn><abstract>Introduction
The best management strategy for patients with atrial fibrillation (AF) with heart failure (HF) and preserved left ventricular ejection fraction (LVEF) is unknown.
Methods and Results
This cohort study was conducted in Olmsted County, Minnesota, with resources of the Rochester Epidemiology Project. Patients with incident AF occurring between 2000 and 2014 with a prior or concurrent HF were included. Patients with LVEF ≥ 50% were designated as HF and preserved ejection fraction (HFpEF) and those with LVEF < 50% were designated as HF and reduced ejection fraction (HFrEF). Rhythm control in the first year after AF diagnosis was defined as prescriptions for an antiarrhythmic drug, catheter ablation, or maze procedure. The primary endpoint was all‐cause mortality. The secondary endpoints were cardiovascular death, cardiovascular hospitalization, and stroke or transient ischemic attack. Of 859 patients (age, 77.2 ± 12.1 years; 49.2%, female), 447 had HFpEF‐AF, and 412 had HFrEF‐AF. There was no difference in all‐cause mortality (10‐year mortality, 83% vs 79%; p = .54) or secondary endpoints between the HFpEF‐AF and HFrEF‐AF, respectively. Compared with the rate control strategy, rhythm control in HFpEF‐AF patients (n = 40, 15.9%) offered no survival benefits (adjusted HR, 0.70; 95% CI, 0.42–1.16; p = .16), whereas rhythm control in HFrEF‐AF patients (n = 52, 22.5%) decrease cardiovascular mortality (HR, 0.38; 95% CI, 0.17–0.86; p = .02).
Conclusions
Patients with HFpEF‐AF and HFrEF‐AF had similar poor prognoses. Rhythm control strategy was seldom adopted in community care in patients with HF and AF. A rhythm control strategy may provide survival benefit for patients with HFrEF‐AF and the benefit of rhythm control in patients with HFpEF‐AF warrants further study.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>32584498</pmid><doi>10.1111/jce.14632</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-9986-0654</orcidid><orcidid>https://orcid.org/0000-0002-5897-9464</orcidid><oa>free_for_read</oa></addata></record> |
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| identifier | ISSN: 1045-3873 |
| ispartof | Journal of cardiovascular electrophysiology, 2020-09, Vol.31 (9), p.2275-2283 |
| issn | 1045-3873 1540-8167 1540-8167 |
| language | eng |
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| source | MEDLINE; Wiley Journals |
| subjects | Aged Aged, 80 and over atrial fibrillation Atrial Fibrillation - diagnosis Atrial Fibrillation - epidemiology Atrial Fibrillation - therapy Cardiac arrhythmia Cardiovascular diseases Catheters Cohort Studies Congestive heart failure Ejection fraction Epidemiology Female Fibrillation Heart failure Heart Failure - diagnosis Heart Failure - epidemiology Heart Failure - therapy heart failure with preserved ejection fraction heart failure with reduced ejection fraction Humans Ischemia Male Minnesota - epidemiology Mortality Prognosis rate control rhythm control Stroke Volume Survival Transient ischemic attack Ventricle Ventricular Function, Left |
| title | Outcomes of incident atrial fibrillation in heart failure with preserved or reduced ejection fraction: A community‐based study |
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