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The difference in association of atrial fibrillation and sinus rhythm with heart failure with reduced, mid-range and preserved ejection fraction.
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1Scientific Research Institute of Cardiology and Internal Diseases - Almaty - Kazakhstan
Background:Atrial fibrillation (AF) is a common disorder in patients with heart failure, mostly with reduced left ventricular ejection fraction (LVEF). The prevalence of AF in HF with preserved EF and HF midrange EF is less well known.
Aim of the study:to evaluate the association of AF with HF with preserved, midrange and reduced EF.
Material and methods:in population-based survey 1544 people with cardiovascular diseases were selected. Authors assessed prevalence of and association of AF and HFrEF versus HFmrEF versus HFpEF.
Results: of 1544 patients with cardiovascular disorders 56,84% with non-valvular AF (1 group) and 43,16% without AF (2 group). The number of men was higher in AF group (63,7%) versus non-AF group (46,4%). The number of patients in both groups decreased with decreasing LVEF, HFrEF 16,3% in 1 group and 6,8% in the 2 group, HFmrEF 21,5% and 7,4% and HFpEF 62,5% and 85,7%, respectively.
When compared two groups in association with HFrEF some characteristics had significant relationships with AF. Thus, 78,9% men in AF group versus 33% in sinys rhythm group (OR:7,5; CI:3,68-15,8), more often prior stroke 22% versus 8% (OR:3,1; CI: 1,1-8,6). The association of rest risk factors in patients with HFrEF in both groups was non-significant.
The same tendency was in the group with HFpEF. Statistically, the percentage of men with HFpEF was higher in AF group versus sinus rhythm 57,3% and 42,4% (OR:1,8; CI:1,4-2,3), prior stroke- 15% and 8,9 % (OR:1,86; CI:1,29-2,68) respectively. The group with HFpEF different from HFrEF in correlation with hypertension 84% in patients with versus 93% without AF (OR:0,35; CI:0,24-0,53), with age =65 years 53,7% in the 1 group and 31% in the 2 group (OR:0,38; CI:0,3-0,4).
In both EF group, no association with previous myocardial infarction and AF was observed.
In HFmrEF, beside different in aged patients older than 65 years in AF group 58% versus sinus rhythm 41,5% (OR:0,5; CI:0,28-0,9), the correlation between previous myocardial infarction and AF was observed, 28,7% patients with AF and 60% with sinus rhythm (OR:0,26; CI:0,14-0,49).
Conclusion: AF was associated with clinical characteristics such as male gender and prior stroke in HFrEF and HFpEF, with aged population in HFpEF and HFmrEF. There wasn’t association with previous myocardial infarction and HFpEF and HFrEF. In contrast, there was an association with previous myocardial infarction and HFmrEF. The difference in patient characteristics and outcomes in both group depending on LVEF should be explored further.
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