European Heart Journal Advance Access originally published online on November 13, 2006
European Heart Journal 2006 27(23):2866-2870; doi:10.1093/eurheartj/ehl359
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Atrial fibrillation, ischaemic heart disease, and the risk of death in patients with heart failure
1 Department of Cardiology, Bispebjerg University Hospital, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
2 Department of Cardiology, Herlev University Hospital, Herlev, Denmark
3 Department of Cardiology, Esbjerg Hospital, Esbjerg, Denmark
4 Department of Cardiology, Frederiksberg Hospital, Frederiksberg, Denmark
5 Department of Cardiology, Viborg Hospital, Viborg, Denmark
6 Department of Cardiology, Hjørring Hospital, Hjørring, Denmark
7 Department of Cardiology, Roskilde Hospital, Roskilde, Denmark
8 Department of Cardiology, The Heart Centre, University Hospital, Rigshospitalet, Copenhagen, Denmark
9 Department of Cardiology, Glostrup Hospital, Glostrup, Denmark
Received 7 March 2006; revised 19 September 2006; accepted 19 October 2006; online publish-ahead-of-print 13 November 2006.
* Corresponding author. Tel: +45 353 13333; fax: +45 353 13226. E-mail address: odplc{at}mail.dk
See page 2740 for the editorial comment on this article (doi:10.1093/eurheartj/ehl321)
Aims Atrial fibrillation (AF) is a risk factor for death in patients with a myocardial infarction, but highly variable results are reported in patients with heart failure. We studied the prognostic impact of AF in heart failure patients with and without ischaemic heart disease.
Methods and results During a period of 2 years, 3587 patients admitted to hospital because of heart failure were included in this study. All patients were examined by echocardiography and the presence of AF was recorded. Follow-up was available for 8 years. Twenty four percent of those discharged alive from hospital had AF. After 4 and 8 years of follow-up, mortality was higher in patients with AF than in patients without, 56 vs. 52% and 77 vs. 73%, respectively. Cox multivariable regression analysis showed a small but significant importance of AF for long-term mortality [hazard ratio (HR) 1.12, 95% confidence limits (CI), 1.02–1.23, P=0.018]. There was a significant interaction between the importance of AF and the presence of ischaemic heart disease (P=0.034). In patients with AF at the time of discharge and ischaemic heart disease, HR was 1.25 (95% CI: 1.09–1.42) and P<0.001; in patients with AF at discharge and without ischaemic heart disease, HR was 1.01 (95% CI: 0.88–1.16) and P=0.88.
Conclusion AF is associated with increased risk of death only in patients with ischaemic heart disease. This finding may explain the variable results of studies of the prognosis associated with AF in heart failure.
Key Words: Atrial fibrillation • Congestive heart failure • Mortality • Ischaemic heart disease
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