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The effect of trigger on the prognosis of patients with heart failure and atrial fibrillation: tachycardia-mediated acute decompensation
Atrial fibrillation (AF) is common in heart failure (HF) patients. There exists controversy on the prognostic value of AF in HF patients. Patients with AF and HF, who experience acute decompensation mediated by tachycardia may have different prognosis than those whose decompensation is triggered by other factors, because tachycardia may be an acute and reversible event.
Purpose
We investigated the effect of tachycardia-mediated acute decompensation on the clinical outcomes.
Methods
The Korea Acute Heart Failure (KorAHF) registry consecutively enrolled 5,625 patients. The trigger for acute decompensation was classified as either tachycardia-mediated (TM) or not. Atrial fibrillation was confirmed in ECG taken during hospital admission. The primary outcomes were in-hospital mortality and 1-year all cause mortality according to rhythm and trigger.
Results
Among 5,625 patients, 3665 (65%) patients had sinus rhythm and 1961 (35%) had AF. Among patients with AF, 928 (47%) had TM acute decompensation. Patients with sinus rhythm was older than those with AF (Sinus: 67±15 years, AF-TM(-): 71±12 years, AF-TM (+): 70±12 years, P<0.001). Patients with AF-TM(+) had lowest NT-proBNP level (sinus: 9900±11464 pg/microL, AF-TM(-): 8252±9296 pg/microL AF-TM (+): 7462±8945 pg/microL, P<0.001).
Regarding the clinical outcomes, patients with AF-TM(+) had the lowest in-hospital mortality (Sinus: 5.1%, AF-TM(-): 6.5%, AF-TM (+): 1.7%, P<0.001). In multivariable analysis, AF-TM (+) was associated with 53% reduced risk (HR, 0.47; 95% CI, 0.24-0.93).
Regarding the 1-year all-cause death, there was no difference in 1-year survival between patients with sinus and AF (P=0.629). When stratifying the patients according to trigger, AF-TM(+) had the best prognosis, followed by those with sinus rhythm, while AF-TM(-) had the worse prognosis (P=0.002). However, in multivariable analysis, AF-TM (+) was not associated with reduced risk for 1-year all-cause mortality (HR, 0.91; 95% CI, 0.71-1.17).
Conclusions
HF patients with AF whose acute decompensation is triggered by tachycardia have better in-hospital but similar post discharge outcomes like HF patients with sinus rhythm or those with AF who are decompensated by other factors.
In line with the ESC mission, newly presented content is made available to all for a limited time (4 months for ESC Congress, 3 months for other events). ESC Professional Members, Association Members (Ivory & above) benefit from year-round access to all the resources from their respective Association, and to all content from previous years. Fellows of the ESC (FESC), and Professionals in training or under 40 years old, who subscribed to a Young Combined Membership package benefit from access to all ESC 365 content from all events, all editions, all year long. Find out more about ESC Memberships here.
