Atrial fibrillation in heart failure: High mortality risk even if ventricular function is preserved

  • Parkash R
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Abstract

Background: The purpose of this study was to determine if patients with atrial fibrillation (AF) and heart failure (HF) have a better prognosis when systolic function is preserved as compared with those with depressed systolic function. Methods: Data from consecutive patients presenting to the emergency department at Brigham and Women's Hospital from January 1997 to December 2002 who had a diagnosis of AF and HF and a measure of ejection fraction (EF) were reviewed. Vital status was determined from the Social Security Death Index. Results: Of 478 patients (mean age 74 +/- 13 years; 47% women), EF was preserved (>50%) in 46%. Those with preserved left ventricular (LV) function were older (76 vs 72 years, P < .0020), included more women (62 vs 35%, P < .0001), more likely to have a history of hypertension and pulmonary disease and less likely to have had a prior myocardial infarction. At 5 years, mortality was similar between the preserved and depressed EF groups (50% vs 48%, P = .74). In multivariable analysis, age > 75 years, history of cancer, cerebrovascular disease, aortic valve disease, serum creatinine > 2.0 mg/dL, and serum sodium < 130 mmol/L were associated with increased mortality. Therapy with beta-blockers and angiotensin-converting enzyme inhibitors/angiotensin receptor blocker were associated with lower mortality. Conclusion: Patients who present to the emergency department with AF, HF, and preserved LVEF have a similarly high mortality as compared with those with depressed LVEF. Further study is needed to assess the impact of therapies and clarify the reasons for the poor prognosis. 2005 Mosby, Inc. All rights reserved

Author-supplied keywords

  • $$Embase
  • $$Prevalence
  • $$exclude-title-stage-Rachel
  • Aged
  • Aortic Valve
  • Atrial Fibrillation
  • Canada
  • Cardiovascular
  • Death
  • Diagnosis
  • Disease
  • Emergencies
  • Female
  • Heart
  • Heart Failure
  • Heart Failure/di [Diagnosis]
  • Heart Failure/dt [Drug Therapy]
  • Hospital
  • Human
  • Hypertension
  • Infarction
  • Left
  • Male
  • Methods
  • Mortality
  • Multivariate Analysis
  • Myocardial
  • Myocardial Infarction
  • Prognosis
  • Pulmonary Disease
  • Receptor
  • Right
  • Risk
  • Social Security Death Index
  • Sodium
  • United States
  • Ventricular Function
  • age
  • analysis
  • anamnesis
  • angiotensin receptor antagonist/dt [Drug Therapy]
  • aorta valve disease
  • article
  • beta adrenergic receptor blocking agent/dt [Drug T
  • cancer
  • cardiology
  • cerebrovascular disease
  • creatinine
  • creatinine blood level
  • data analysis
  • dipeptidyl carboxypeptidase inhibitor/dt [Drug The
  • disease association
  • emergency
  • emergency ward
  • enzyme
  • groups by age
  • health
  • heart atrium fibrillation/di [Diagnosis]
  • heart atrium fibrillation/dt [Drug Therapy]
  • heart ejection fraction
  • heart infarction
  • heart ventricle function
  • history
  • lung disease
  • major clinical study
  • patient
  • priority journal
  • science
  • serum
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Authors

  • R.Maisel Parkash

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