Construction of A Prediction Model for Atrial Fibrillation in Patients with Dilated Cardiomyopathy and Heart Failure

Dilated cardiomyopathy(DCM)is a common myocardial disease characterized by enlargement of the heart cavity and decreased systolic function,often leading to heart failure(HF)and arrhythmia.The occurrence of atrial fibrillation(AF)is closely related to the progression and prognosis of the disease.In recent years,with the advancement of medical imaging and biomarkers,models for predicting the occurrence of AF in DCM patients have gradually become a research hotspot.This article aims to review the current situation of AF in DCM patients and explore the importance and possible methods of constructing predictive models to provide reference for clinical prevention and treatment.We comprehensively analyzed the risk factors for AF in DCM patients from epidemiological data,pathophysiological mechanisms,clinical and laboratory indicators,electrocardiogram and imaging parameters,and biomarkers,and evaluated the effectiveness of existing predictive models.Through analysis of existing literature and research,this article proposes a predictive model that integrates multiple parameters to improve the accuracy of predicting AF in DCM patients and provide a scientific basis for personalized treatment.

Digoxin:A systematic review in atrial fibrillation,congestive heart failure and post myocardial infarction

AIM: To review digoxin use in systolic congestive heart failure, atrial fibrillation, and after myocardial infarction. METHODS: A comprehensive Pub Med search was performed using the key words "digoxin and congestive heart failure", "digoxin and atrial fibrillation", "digoxin, atrial fibrillation and systolic congestive heart failure", and "digoxin and myocardial infarction". Only articles written in English were included in this study. We retained studies originating from randomized controlled trials, registries and included at least 500 patients. The studies included patients with atrial fibrillation or heart failure or myocardial infarction and had a significant proportion of patients(at least 5%) on digoxin. A table reviewing the different hazard ratios was developed based on the articles selected. Our primary endpoint was the overall mortality in the patients on digoxin vs those without digoxin, among patients with atrial fibrillation and also among patients with atrial fibrillation and systolic heart failure. We reviewed the most recent international guidelines to discuss current recommendations.RESULTS: A total of 18 studies were found that evaluated digoxin and overall mortality in different clinical settings including systolic congestive heart failure and normal sinus rhythm(n = 5), atrial fibrillation with and without systolic congestive heart failure(n = 9), and myocardial infarction(n = 4). Overall, patients with systolic congestive heart failure with normal sinus rhythm, digoxin appears to have a neutral effect on mortality especially if close digoxin level monitoring is employed. However, most of the observational studies evaluating digoxin use in atrial fibrillation without systolic congestive heart failure showed an increase in overall mortality when taking digoxin. In the studies evaluated in this systematic review, the data among patients with atrial fibrillation and systolic congestive heart failure, as well as post myocardial infarction were more controversial. The extent to which discrepancies among studies are based on statistical methods is currently unclear, as these studies' findings are generated by retrospective analyses that employed different techniques to address confounding. CONCLUSION: Based on the potential risks and benefits, as well as the presence of alternative drugs, there is a limited role for digoxin in the management of patients with normal sinus rhythm and congestive heart failure. Based on the retrospective studies reviewed there is a growing volume of data showing increased mortality in those with only atrial fibrillation. The pro-per role of digoxin is, however, less certain in other subgroups of patients, such as those with both atrial fibrillation and systolic congestive heart failure or after a myocardial infarction. Further studies may provide helpful information for such subgroups of patients.

Catheter ablation for atrial fibrillation in heart failure:untying the Gordian knot

Atrial fibrillation(AF) and heart failure(HF) are complex clinical entities that occur concomitantly in a significant population of patients, and their prevalence is rising in epidemic proportions. Traditionally, both rate and rhythm control strategies have been regarded as equivalent in the management of dysrhythmia in this AF-HF cohort with escalation of treatment largely guided by symptoms. Both disorders are involved in an elaborate pathophysiological interplay with shared cardiovascular risk factors that contribute to the development and sustenance of both AF and HF. Recent studies and continued development of evidence to support catheter ablation for AF has brought into question the traditional belief in equivalence between rate and rhythm control. Indeed, recent trials, in particular the CASTLE-AF(Catheter Ablation versus Standard Conventional Therapy in Patients with Left Ventricular Dysfunction and Atrial Fibrillation) study, suggest that catheter ablation for AF improves survival and rates of hospitalisation in patients with concomitant HF and AF, threatening a paradigm shift in the management of this patient cohort. The evident mortality benefit from clinical trials suggests that catheter ablation for AF should be considered as a therapeutic intervention in all suitable patients with the AF-HF syndrome as these patients may derive the greatest benefit from restoration of sinus rhythm. Further research is needed to refine the evidence base, especially to determine which subgroup of HF patients benefit most from catheter ablation and what is the optimal timing.

Clinical characteristics and prognostic impact of atrial fibrillation in patients with chronic heart failure

AIM To assess the prevalence, clinical characteristics and independent prognostic impact of atrial fibrillation(AF) in chronic heart failure(CHF) patients, and the potential protective effect of disease-modifying medications, particularly beta-blockers(BB). METHODS We retrospectively reviewed the charts of patients referred to our center since January 2004, and collected all clinical information available at their first visit. We assessed mortality to the end of June 2015. We compared patients with and without AF, and assessed the association between AF and all-cause mortality by multivariate Cox regression and Kaplan-Meyer analysis, particularly accounting for ongoing treatment with BB.RESULTS A total of 903 patients were evaluated(mean age 68 ± 12 years, 73% male). Prevalence of AF was 19%, ranging from 10% to 28% in patients ≤ 60 and ≥ 77 years, respectively. Besides the older age, patients with AF had more symptoms(New York Heart Association II-III 60% vs 44%), lower prevalence of dyslipidemia(23% vs 37%), coronary artery disease(28% vs 52%) and left bundle branch block(9% vs 16%). On the contrary, they more frequently presented with an idiopathic etiology(50% vs 24%), a history of valve surgery(13% vs 4%) and received overall more devices implantation(31% vs 21%). The use of disease-modifying medications(i.e., BB and ACE inhibitors/angiotensin receptor blockers) was lower in patients with AF(72% vs 80% and 71% vs 79%, respectively), who on the contrary were more frequently treated with symptomatic and antiarrhythmic drugs including diuretics(87% vs 69%) and digoxin(51% vs 11%). At a mean follow-up of about 5 years, all-cause mortality was significantly higher in patients with AF as compared to those in sinus rhythm(SR)(45% vs 34%, P value < 0.05 for all previous comparisons). However, in a multivariate analysis including the main significant predictors of allcause mortality, the univariate relationship between AF and death(HR = 1.49, 95%CI: 1.15-1.92) became not statistically significant(HR = 0.98, 95%CI: 0.73-1.32). Nonetheless, patients with AF not receiving BB treatment were found to have the worst prognosis, followed by patients with SR not receiving BB therapy and patients with AF receiving BB therapy, who both had similarly worse survival when compared to patients with SR receiving BB therapy.CONCLUSION AF was highly prevalent and associated with older age, worse clinical presentation and underutilization of disease-modifying medications such as BB in a population of elderly patients with CHF. AF had no independent impact on mortality, but the underutilization of BB in this group of patients was associated to a worse long-term prognosis.

Methods for the development and assessment of atrial fibrillation and heart failure dog models

Objective To report Medtronic experiences with the development of animal models for atrial fibrillation （AF） and chronic heart failure （CHF） using high-rate pacing for AF and microemboli for CHF. Methods For the AF model, an atrial lead was attached to a Medtronic SynergyTM neurostimulator, which was programmed to stimulate at 50 Hz in an on-off duty cycle. Atrial natfiuretic peptide （ANP）, brain natriuretic peptide （BNP） and N-terminal pro brain nalriuretic peptide （NT-proBNP） were assayed at select time points. For CHF model, a serial injection of 90 μm polystyrene microspheres at 62,400 beads/mL （Polybead, Polysciences, Inc.） was performed to induce global ischemia, either with weekly monitoring and embolization schedule （group 1, n = 25） or with biweekly monitoring and emboliation schedule （group 2, n = 36 ）. Echocardiograms were used along with ventriculograms and magnetic resonance imaging scans weekly to assess cardiac function and ANP, BNP and NT-proBNP were monitored. Results For the AF model, the days to sustained AF for four animals following surgery were 7, 25, 21 and 19, respectively; For the CHF model, the days to meet CHF endpoints were 116 in group 1 and 89 in group 2. For both AF and CHF models, NT-proBNP correlated well with the development of disease states. Conclusion Our experience for the development and assessment of AF and CHF dog models may help researchers who are in search for animal model for assessing the safety and efficacy of a device-based therapy.

Incident frailty and cognitive impairment by heart failure status in older patients with atrial fibrillation: the SAGE-AF study

Background Atrial fibrillation(AF) and heart failure(HF) frequently co-occur in older individuals. Among patients with AF, HF increases risks for stroke and death, but the associations between HF and incident cognition and physical impairment remain unknown. We aimed to examine the cross-sectional and prospective associations between HF, cognition, and frailty among older patients with AF. Methods The SAGE-AF(Systematic Assessment of Geriatric Elements in AF) study enrolled 1244 patients with AF(mean age 76 years, 48% women) from five practices in Massachusetts and Georgia. HF at baseline was identified from electronic health records using ICD-9/10 codes. At baseline and 1-year, frailty was assessed by Cardiovascular Health Survey score and cognition was assessed by the Montreal Cognitive Assessment. Results Patients with prevalent HF(n = 463, 37.2%) were older, less likely to be non-Hispanic white, had less education, and had greater cardiovascular comorbidity burden and higher CHA2 DS2 VASC and HAS-BLED scores than patients without HF(all P's < 0.01). In multivariable adjusted regression models, HF(present vs. absent) was associated with both prevalent frailty(adjusted odds ratio [a OR]: 2.38, 95% confidence interval [CI]: 1.64-3.46) and incident frailty at 1 year(a OR: 2.48, 95% CI: 1.37-4.51). HF was also independently associated with baseline cognitive impairment(a OR: 1.60, 95% CI: 1.22-2.11), but not with developing cognitive impairment at 1 year(a OR 1.04, 95%CI: 0.64-1.70). Conclusions Among ambulatory older patients with AF, the co-existence of HF identifies individuals with physical and cognitive impairments who are at higher short-term risk for becoming frail. Preventive strategies to this vulnerable subgroup merit consideration.

Beta-blockers and 1-year clinical outcomes in hospitalized heart failure patients with atrial fibrillation

OBJECTIVE To assess the association between beta-blockers and 1-year clinical outcomes in heart failure(HF)patients with atrial fibrillation(AF),and further explore this association that differs by left ventricular ejection fraction(LVEF)level.METHODS We enrolled hospitalized HF patients with AF from China Patient-centered Evaluative Assessment of Cardiac Events Prospective Heart Failure Study.COX proportional hazard regression models were employed to calculate hazard ratio of betablockers.The primary outcome was all-cause death.RESULTS Among 1762 HF patients with AF(756 women[41.4%]),1041(56%)received beta-blockers at discharge and 1272(72.2%)had an LVEF>40%.During one year follow up,all-cause death occurred in 305(17.3%),cardiovascular death occurred in203 patients(11.5%),and rehospitalizations for HF occurred in 622 patients(35.2%).After adjusting for demographic characteristics,social economic status,smoking status,medical history,anthropometric characteristics,and medications used at discharge,the use of beta-blockers at discharge was not associated with all-cause death[hazard ratio(HR):0.86;95%Confidence Interval(CI):0.65-1.12;P=0.256],cardiovascular death(HR:0.76,95%CI:0.52-1.11;P=0.160),or the composite outcome of all-cause death and HF rehospitalization(HR:0.97,95%CI:0.82-1.14;P=0.687)in the entire cohort.There were no significant interactions between use of beta-blockers at discharge and LVEF with respect to all-cause death,cardiovascular death,or composite outcome.In the adjusted models,the use of beta-blockers at discharge was not associated with all-cause death,cardiovascular death,or composite outcome across the different levels of LVEF:reduced(<40%),mid-range(40%-49%),or preserved LVEF(≥50%).CONCLUSION Among HF patients with AF,the use of beta-blockers at discharge was not associated with 1-year clinical outcomes,regardless of LVEF.

Cognitive impairment in heart failure patients： role of atrial fibrillation

Author＇s reply We read with great interest the letter of Yiginer, et al.regarding the influence of atrial fibrillation （AF） in the development of cognitive impairment in heart failure （HF） patients. The comment is related to the review published in the Journal by Leto, et al. that was a systematic overview about cognition, pathophysiology of cognitive impairment in heart failure patients. In the letter, Yiginer, et al.

Effects of Bisoprolol on the ventricular function and hemodynamics in patients with atrial fibrillation and chronic heart failure

Background: Recent data suggest that beta-blockers can be beneficial in patients with chronic heart failure (CHF). Atrial fibrillation (AF) is present in a significant number of patients with CHF and is associateing with significant morbidity and increasing mortality rates. Thus it is necessary to establish therapy to improve the poor prognosis in this high-risk population, but a specific benefit of beta-blockers to the subset with concomitant AF and CHF has been little demonstrated. Objective: To examine the effects of Bisoprolol (6 months treatment) on the ventricular function and hemodynamics in patients with AF and CHF. Methods: 84 patients with stable CHF (NYHA≤Ⅲ class) and AF were assigned to Treated Group( n = 37) or Control group Ⅰ ( n = 22, 24-hour heart mean rate < 70/min) or Control Group Ⅱ ( n = 25, 24-hour heart mean rate ≥ 70/min) . All patients were given the basic therapy for CHF, and Treated Group received Bisopolol. Clinical and echocardiographic variables were measured in 3 groups at baseline and after 6 months, and the results were compared . Results: After 6 months of treatment with Bisoprolol, left ventricular ejection fraction (LVEF) and NYHA class had significandy improved (P < 0.05), and a trend towards a reduction in combined end point of death or CHF hospitalization was also observed (P < 0.20) in Treated Group; The increase of LVEF in Treated Group were associated with a reduction in mitral regurgitation degree and left atrial volume; The heart rate in mean 24-hour and at peak exercise decreased in Treated Group, but were similar to that in Control Group Ⅰ. Conclusion: 6 months of Bisoprolol therapy resulted in an improvement in the NYHA class and LVEF, and also showed a trend towards a reduction in hospitalization or death. The beneficial effects of Bisoprolol on patients with AF and CHF may be partly mediated by improvement of ventricular diastolic function.

Current Management Strategies in Patients with Heart Failure and Atrial Fibrillation:A Review of the Literature

Heart Failure(HF)and Atrial Fibrillation(AF)are common diseases which lead to signifi cant morbidity and mortality.Each disease can be a challenge to treat clinically,especially when they present together.We performed a review of the literature including clinical trials,metanalyses,and guidelines regarding the management of patients with HF and AF.This review describes the pathophysiologic mechanisms behind each disease state,their associated prognosis,and epidemiologic features.Strategies for prevention of stroke in patients with AF,including use of novel oral anticoagulants as well as prevention of the development of AF are discussed.We review the medical and catheter-based therapies for AF and present an original algorithm for the management of AF in patients with HF.

Pulsed and Tissue Doppler Echocardiographic Abnormalities in Patients with Diastolic Heart Failure with and without Atrial Fibrillation

Background: Symptoms of heart failure (HF) are identical in both systolic (SHF) and diastolic hear failure (DHF). The prevalence of atrial fibrillation (AF) in heart failure varies in different studies depending on the criteria of enrollment and the use of echocardiographic parameters in the definition of HF. Aim: To assess the clinical characteristic of pa- tients with DHF complicated by AF and compare with those with SHF in regard of echocardiographic abnormalities and causative agents. Furthermore, evaluate the clinical and biochemical markers for the prediction of AF in HF. Method: Over the duration of 12 months, each patient diagnosed as HF based on admission code was enrolled in the study. Patients were classified into two groups: group 1: DHF, with preserved LVPEF% > 50%, n = 204 (60%), and group 2, with SHF, with LVREF% ≤ 50%, n = 140 (40%). The presence or absence of AF on ECG was recorded. The predictive value of different clinical and biochemical variables for the development of AF was evaluated using logistic multiple regression analysis. Results: Three hundred and forty four eligible patients were admitted to hospital with heart failure out of 7650 who had other medical problems. The prevalence of HF in this population was 4.5%, those with DHF were 2.7% and SHF of 1.8%. The incidence of AF on ECG was 35% in the whole study population and 65% were in sinus rhythm (SR). The occurrence of AF was twice higher in DHF patients of 22% compared with 11% in SHF. Echo pulsed Doppler in DHF and AF compared with those in SR showed a severe restrictive pattern with significantly thick septum wall, higher LV mass index, shorter DT and higher E/e? ratio of 12.4 vs. 9.73, P 0.05. The predictive risk (odd ratio) of different clinical variables for development of AF in HF was positive for LV hypertrophy on ECG of 2.4, history of hypertension of 1.6, history of DM of 1.4, BMI > 28 of 1.7. Conclusions: The prevalence of HF was 4.5% in the study population, with SHF of 1.8% and DHF of 2.7%. Patients with DHF and AF were older with a higher female ratio with severe restrictive pattern compared with those of SHF. The incidence of AF in the whole study was 35%. The best predictor of AF in HF was left ventricle hypertrophy followed by history of hypertension and DM.

Clinical Heart Failure Patients with Ischemic Stroke Have a High Incidence (>60%) of Atrial Fibrillation or Flutter Whether Systolic Function Is Preserved or Depressed

Clinical congestive heart failure (CHF) is a major risk factor for strokes. Patients with CHF commonly have atrial fibrillation or flutter (AF), which is frequently associated with, may be a marker for, and may be the mechanism of, ischemic strokes. To determine whether stroke patients with CHF have a high incidence of AF (that may be intermittent and not diagnosed), we reviewed all the 12 lead ECGs in a fourteen year institutional ECG data base and the clinical records and the available echocardiograms of 985 patients who had an ischemic stroke over a 3-year period. We found that 31.3% of the stroke patients had evidence of AF. Clinical congestive heart failure was present in 168 stroke patients;61.9% of these stroke patients with CHF had evidence of AF. In the total stroke population, patients with other risk factors for stroke (hypertension, advanced age, diabetes, coronary artery disease) had an increased incidence of AF;but among stroke patients with CHF, only advanced age (≥75 years) in addition to CHF increased the incidence of AF. To determine whether only the CHF stroke pts with systolic dysfunction had a high incidence of AF, we compared the incidence of AF in the 41.5% of the CHF patients with a depressed ejection fraction with the AF incidence in the 58.5% of CHF stroke patients with a normal ejection fraction (≥50%). The incidence of AF was the same (63.4% vs. 60.2%, p = 0.741) whether the ejection fraction was depressed or normal. These findings suggest that AF is common in patients with CHF who have strokes whether the ejection fraction is normal or depressed. CHF patients who have strokes and who are in sinus rhythm should be meticulously investigated for intermittent AF, so anticoagulation can be administered to prevent a further stroke.

A Brief Review of a Common Clinical Question: Intravenous Diltiazem or Metoprolol for Atrial Fibrillation with Rapid Ventricular Response?

Two classes of rate controlling medications—beta blockers (BBs) and non- dihydropyridine calcium channel blockers (CCBs)—are given to patients who present with atrial fibrillation (AF) with rapid ventricular response (RVR). Both are Class I recommendations from the American Heart Association (AHA), American College of Cardiology (ACC), and Heart Rhythm Society (HRS) for the management of AF with RVR. Multiple studies support the view that diltiazem is more effective than metoprolol, even though data from the AFFIRM trial suggests BBs are more frequently used. CCBs are generally avoided in AF with RVR patients who have concomitant heart failure with reduced ejection fraction (HFrEF) for concern of triggering decompensation. However, some recent studies indicate this idea may be unfounded. The aim of this article is to compare the efficacy of diltiazem and metoprolol for rate control in AF with RVR and examine the use of diltiazem in patients with both AF with RVR and HFrEF.

Atrial fibrillation in heart failure: The sword of damocles revisited

Heart failure (HF) and atrial fibrillation (AF) frequently coexist and have emerged as major cardiovascular epidemics. There is growing evidence that AF is an independent prognostic marker in HF and affects patients with both reduced as well as preserved LV systolic function. There has been a general move in clinical practice from a rhythm control to a rate control strategy in HF patients with AF, although recent data suggests that rhythm control strategies may provide better outcomes in selected subgroups of HF patients. Furthermore, various therapeutic modalities including pace and ablate strategies with cardiac resynchronisation or radio-frequency ablation have become increasingly adopted, although their role in the management of AF in patients with HF remains uncertain. This article presents an overview of the multidimensional impact of AF in patients with HF. Relevant literature is highlighted and the effect of various therapeutic modalities on prognosis is discussed. Finally, while novel anticoagulants usher in a new era in thromboprophylaxis, research continues in avariety of new pathways including selective atrial anti-arrhythmic agents and genomic polymorphisms in AF with HF.

Prognostic impact of atrial fibrillation on clinical outcomes of acute coronary syndromes,heart failure and chronic kidney disease

Atrial fibrillation(AF) is the most common type of sustained arrhythmia,which is now on course to reach epidemic proportions in the elderly population. AF is a commonly encountered comorbidity in patients with cardiac and major non-cardiac diseases. Morbidity and mortality associated with AF makes it a major healthcare burden. The objective of our article is to determine the prognostic impact of AF on acute coronary syndromes,heart failure and chronic kidney disease. Multiple studies have been conducted to determine if AF has an independent role in the overall mortality of such patients. Our review suggests that AF has an independent adverse prognostic impact on the clinical outcomes of acute coronary syndromes,heart failure and chronic kidney disease.

Atrial fibrillation may be a hidden factor for the development of cognitive impairment in patients with heart failure

To the editor We read the article entitled Cognitive impairment in heart failure patients＇ by Leto, et al. with great interest. In this review, they demonstrated pathophysiological determinants of cognitive impairment in heart failure （HF） population.

Atrial fibrillation ablation in patients with heart failure review

Atrial fibrillation and heart failure often coexist in patients with advanced heart failure symptoms. The result, in addition to a significant impact on quality of life, is an increase in the risk of a adverse clinical outcomes including stroke, hospitalization and overall mortality. Pharmacological therapy for atrial fibrillation in the heart failure population remains limited due to sub-optimal drug efficacy and a likely increased mortality due to pro-arrhythmia. Atrial fibrillation ablation, since it allows for therapy without the need for toxic medication, has the potential to become mainstream treatment in patients with drug refractory, symptomatic atrial fibrillation and heart failure. Randomized studies and observational data suggest that atrial fibrillation ablation provides superior rhythm control to anti-arrhythmic drugs. Atrial fibrilla- tion ablation is relatively safe and may result in improvement of left ventricular function and quality of life. Ongoing studies are attempting to assess a number of outcome measures to help define its role in the heart failure patient population. This review focuses on atrial fibrillation ablation in patients with congestive heart failure, and summarizes the results of available literature.

Serum uric acid levels correlate with atrial fibrillation in patients with chronic systolic heart failure

Background Studies have shown that increased levels of serum uric acid （SUA） are associated with atrial fibrillation （AF）. However, less is known about the prognostic value of SUA levels for AF in patients with chronic heart failure （CHF）. The aim of the study was to examine the prognostic value of SUA levels for AF in patients with CHF. Methods Sixteen thousand six hundred and eighty-one patients diagnosed with CHF from 12 hospitals were analyzed. Patients were categorized into AF group and non-AF group, death group, and survival group according to the results of the patients＇ medical records and follow-up. Univariate and multivariate Cox proportional hazards analyses were performed to examine the risk of AF. The sensitivity and specificity of SUA level in predicting the prognosis were examined by multivariate Cox models and receiver operating characteristic （ROC） curves. Results The results of univariate predictors in overall patients showed that the higher SUA level was associated with AF. SUA level （HR, 1.084; 95% CI, 1.017-1.144; P 〈0.001）, diuretics （HR, 1.549; 95% CI, 1.246-1.854; P 〈0.001）, and New York Heart Association （NYHA） （HR, 1.237; 95% CI, 1.168-1.306; P 〈0.001） function class were the independent risk factors for AF. The sensitivity and specificity of the models were 29.6% and 83.8% respectively for predicting AF. When SUA level was added to these models, it remained significant （Wald Z2, 1494.88; P 〈0.001 for AF）; 58.8% （95% CI, 57.7%-60.0%） of the observed results were concordant with the separate model. Conclusion Higher SUA level is associated strongly with AF in patients with CHF. SUA level can increase the sensitivity and specificity in predicting AF.

Short-term outcome of chronic heart failure with atrial fibrillation in two hospitals cohort study

Background The epidemiologic features and outcomes of chronic heart failure（CHF） patients with atrial fibrillation（AF） remain not clear in China.We aim to evaluate the epidemiologic features and outcomes of CHF patients with AF,compared by those CHF patients with sinus rhythm（SR）,which is still not clear in China.Methods From January 2005 to December 2008,1161 patients were admitted to the PLA general hospitals and First Affiliated Hospital of Shantou University Medical College with a discharge diagnosis of CHF were enrolled in the study.The patients were divided into two groups according to the presence or absence of AF.The main outcomes were defined as death within one year and readmission to the hospital for heart failure.Results The rate of CHF patients with AF was 36 %.During 1 year follow-up,the overall main outcomes was higher in AF patients than in those with SR（P = 0.02）.After adjusting for other covariables,including age,gender,left ventricular ejection fraction（LVEF）,NYHA classification,et al,AF was no longer related to increased the risk of main outcomes during 1 year follow-up（RR：1.052,CI：0.938 ± 1.165,P = 0.629）.A Cox model showed that risk of main outcomes were associated with NYHA Ⅳ（P 〈 0.001）,age（P = 0.022）,left atrial dimension（P = 0.020）.Conclusion The generally observed higher adverse outcome during 1-year follow-up in patients with AF thus seems to be related to other factors,such as NYHA Ⅳ,age,left atrial dimension,but not AF.

Discharge heart rate and 1-year clinical outcomes in heart failure patients with atrial fibrillation

Background: The association between heart rate and 1-year clinical outcomes in heart failure (HF) patients with atrial fibrillation (AF), and whether this association depends on left ventricular ejection fraction (LVEF), are unclear. We investigated the relationship between discharge heart rate and 1-year clinical outcomes after discharge among hospitalized HF patients with AF, and further explored this association that differ by LVEF level.Methods: In this analysis, we enrolled 1760 hospitalized HF patients with AF from the China Patient-centered Evaluative Assessment of Cardiac Events Prospective Heart Failure study from August 2016 to May 2018. Patients were categorized into three groups with low (<65 beats per minute [bpm]), moderate (65-85 bpm), and high (≥86 bpm) heart rate measured at discharge.Cox proportional hazard models were employed to explore the association between heart rate and 1-year primary outcome, which was defined as a composite outcome of all-cause death and HF rehospitalization.Results: Among 1760 patients, 723 (41.1%) were women, the median age was 69 (interquartile range [IQR]: 60-77) years, median discharge heart rate was 75 (IQR: 69-84) bpm, and 934 (53.1%) had an LVEF <50%. During 1-year follow-up, a total of 792 (45.0%) individuals died or had at least one HF hospitalization. After adjusting for demographic characteristics, smoking status, medical history, anthropometric characteristics, and medications used at discharge, the groups with low (hazard ratio [HR]: 1.32, 95% confidence interval [CI]: 1.05-1.68,P = 0.020) and high (HR: 1.34, 95% CI: 1.07-1.67,P = 0.009) heart rate were associated with a higher risk of 1-year primary outcome compared with the moderate group. A significant interaction between discharge heart rate and LVEF for the primary outcome was observed (P for interaction was 0.045). Among the patients with LVEF ≥50%, only those with high heart rate were associated with a higher risk of primary outcome compared with the group with moderate heart rate (HR: 1.38, 95% CI: 1.01-1.89,P = 0.046), whereas there was no difference between the groups with low and moderate heart rate. Among the patients with LVEF <50%, only those with low heart rate were associated with a higher risk of primary outcome compared with the group with moderate heart rate (HR: 1.46, 95% CI: 1.09-1.96,P = 0.012), whereas there was no difference between the groups with high and moderate heart rate.Conclusions: Among the overall HF patients with AF, both low (<65 bpm) and high (≥86 bpm) heart rates were associated with poorer outcomes as compared with moderate (65-85 bpm) heart rate. Among patients with LVEF ≥50%, only a high heart rate was associated with higher risk;while among those with LVEF <50%, only a low heart rate was associated with higher risk as compared with the group with moderate heart rate.Trail Registration: Clinicaltrials.gov;NCT02878811.