TY - JOUR

T1 - Atrial fibrillation, ischaemic heart disease, and the risk of death in patients with heart failure

AU - Pedersen, Ole Dyg

AU - Søndergaard, Peter

AU - Nielsen, Tonny

AU - Nielsen, Søren Junge

AU - Nielsen, Eric Steen

AU - Falstie-Jensen, Niels

AU - Nielsen, Ingolf

AU - Køber, Lars

AU - Burchardt, Hans

AU - Seibaek, Marie

AU - Torp-Pedersen, Christian

AU - DIAMOND study group investigators

N1 - Keywords: Aged; Aged, 80 and over; Atrial Fibrillation; Denmark; Female; Heart Failure; Hospital Mortality; Humans; Male; Middle Aged; Myocardial Ischemia; Prognosis; Regression Analysis; Risk Factors

PY - 2006

Y1 - 2006

N2 - 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.

AB - 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.

U2 - 10.1093/eurheartj/ehl359

DO - 10.1093/eurheartj/ehl359

M3 - Journal article

C2 - 17101637

VL - 27

SP - 2866

EP - 2870

JO - European Heart Journal

JF - European Heart Journal

SN - 0195-668X

IS - 23

ER -