European Heart Journal Advance Access published online on October 15, 2009
European Heart Journal, doi:10.1093/eurheartj/ehp422
Atrial fibrillation and long-term prognosis in patients hospitalized for heart failure: results from heart failure survey in Israel (HFSIS)
1 Heart Institute, Hillel Yaffe Medical Center, Hadera 38100, Israel
2 Recanati Center, Rabin Medical Center, Beilinson Campus, Petah Tiqwa, Israel
3 Department of Cardiology, Lady Davis Carmel Medical Center, Haifa, Israel
4 Department of Medicine D, Sheba Medical Center, Tel Hashomer, Israel
5 Department of Medicine F, Soroka University Hospital, Beer Sheva, Israel
6 Neufeld Cardiac Research Institute, Sheba Medical Center, Tel Hashomer, Israel
7 Department of Medicine F, Wolfson Medical Center, Holon, Israel
8 Department of Cardiology, Kaplan Medical Center, Rehovot, Israel
9 Department of Cardiology, Bikur Cholim Hospital, Jerusalem, Israel
Received 4 December 2008; revised 16 June 2009; accepted 20 August 2009 * Corresponding author. Tel: +972 4 6304656, Fax: +972 4 6304422, Email: shotana{at}yahoo.com
Aims: Atrial fibrillation (AF) and heart failure (HF) commonly coexist, and each adversely affects the other. The aim of the study was to prospectively evaluate the impact of AF and its subtypes on management, and early and long-term outcome of hospitalized HF patients.
Methods and results: Data were prospectively collected on HF patients hospitalized in all public hospitals in Israel as part of a national survey (HFSIS). Atrial fibrillation patients were subdivided into intermittent and chronic AF subgroups. During March–April 2003, we enrolled 4102 HF patients, of whom 1360 (33.2%) had AF [600 (44.1%) intermittent, 562 (41.3%) chronic]. Patients with AF were older (76.9 ± 10.5 vs. 71.7 ± 12.6 years, P = 0.0001), males, with preserved LV systolic function. Crude mortality rates for AF patients were progressively and consistently higher during hospitalization and during the 4-year follow-up period, especially in the chronic AF group (P = 0.0001). After covariate adjustment, AF was associated with increased 1-year mortality [HR 1.19, 95% CI (1.03–1.36)].
Conclusion: AF was present in a third of hospitalized HF patients, and identified a population with increased mortality risk, largely due to co-morbidities.
Key Words: Atrial fibrillation • Heart failure • Prognosis
The survey was conducted cooperatively by the Israel Society of Internal Medicine, the Israel Heart Society, the Working Group on Heart Failure, and the Israel Center for Disease Control (ICDC), Ministry of Health, under the auspices of the Israel Medical Association. Data Processing and analysis was conducted by the Israel Society for Prevention of Heart Attacks (ISPHA).