Copyright © 2000 by the European Society of Cardiology.
Prognostic value of the presence and development of atrial fibrillation in patients with advanced chronic heart failure
Department of Cardiology/Thoraxcenter, University Hospital Groningen
COEUR/Department of Internal Medicine, University Hospital Dijkzigt, Rotterdam, The Netherlands
revised December 21, 1999; accepted December 22, 1999
Abstract
Aims To examine whether the presence, or development, of atrial fibrillation in patients with advanced chronic heart failure, is associated with a poorer prognosis, compared to patients with sinus rhythm and chronic heart failure.
Methods and Results We examined 409 patients with moderate to severe chronic heart failure, and compared patients with sinus rhythm (n=325) to those with atrial fibrillation (n=84). At baseline, the two groups were similar regarding most indices of severity of chronic heart failure, such as left ventricular ejection fraction (0·23) and New York Heart Association (NYHA) functional class, while they were different for age (70 years for atrial fibrillation vs 67 years for sinus rhythm patients), aetiology of chronic heart failure, blood pressure, concomitant treatment, and plasma neurohormones (all P<0·05). During a mean follow-up of 3·4 years (range 2·0–5·4), 203 patients (50%) died. The majority of deaths was due to progressive chronic heart failure (55%) or was sudden (28%), but there was no difference in mode of death between sinus rhythm and atrial fibrillation patients. Overall mortality was higher in atrial fibrillation patients (60%), than in those with sinus rhythm (47%; risk ratio 1·40, 95% CI 1·01–1·92, P=0·04). After adjusting for important prognostic variables, such as age, left ventricular ejection fraction, NYHA class, renal function, and blood pressure, the presence of atrial fibrillation was no longer related to increased mortality (risk ratio 0·86, range 0·59–1·24,P =ns). Of the 325 patients who had sinus rhythm at baseline, 30 (9%) developed atrial fibrillation during the study. These patients were older (70 vs 66 years, P<0·007), and had slightly lower blood pressure and plasma norepinephrine concentrations (P<0·05), but were otherwise similar. During follow-up, mortality was similar in these two groups (47% in those with new onset atrial fibrillation, vs 47% in those who had sinus rhythm throughout the study).
Conclusions The present data do not support the concept that the presence, or the development of atrial fibrillation in patients with advanced chronic heart failure is independently related to an adverse outcome during long-term follow-up. The generally observed higher mortality in patients with atrial fibrillation thus seems to be related to other factors, associated with atrial fibrillation.
Key Words: Atrial fibrillation, chronic heart failure, prognosis
f1 Correspondence: Prof. Dr H. J. G. M. Crijns, Department of Cardiology/Thoraxcenter, University Hospital Groningen, P.O. Box 30 001, 9700 RB Groningen, The Netherlands.
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