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Med Clin (Barc). 2018 May 23;150(10):376-382. doi: 10.1016/j.medcli.2017.06.065. Epub 2017 Sep 1.

Influence of atrial fibrillation on the mortality of patients with heart failure with preserved ejection fraction.

[Article in English, Spanish]

Author information

1
Servicio de Medicina Interna, Hospital Universitario Quirón Dexeus, Barcelona, España. Electronic address: jonathan.franco@quironsalud.es.
2
Programa de Geriatría, Servicio de Medicina Interna, Hospital Universitari de Bellvitge, Institut d'Investigació Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, España.
3
Servicio de Medicina Interna, Hospital Vega Baja, Orihuela, Alicante, España.
4
Servicio de Medicina Interna, Hospital de Manises, Manises, Valencia, España.
5
Servicio de Medicina Interna, Hospital Comarcal de Zafra, Zafra, Badajoz, España.
6
Servicio de Medicina Interna, Hospital Universitario Lucus Augusti, Lugo, España.
7
Servicio de Medicina Interna, Hospital Universitario Central de Asturias, Oviedo, Asturias, España.
8
Servicio de Medicina Interna, Corporació Sanitària Parc Taulí, Sabadell, Barcelona, España.
9
Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, España.
10
Servicio de Medicina Interna, Hospital Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Córdoba, España.

Abstract

INTRODUCTION AND OBJECTIVES:

The impact of atrial fibrillation (AF) on the prognosis of heart failure with preserved ejection fraction (HFpEF) is still the subject of debate. We analysed the influence of AF on the prognosis on mortality and readmission in patients with HFpEF.

METHODS:

Prospective observational study in 1,971 patients with HFpEF, who were admitted for acute heart failure. Patients were divided into 2 groups according to the presence or absence of AF. We analysed mortality, readmissions and combined mortality/readmissions at one year follow-up.

RESULTS:

A total of 1,177 (59%) patients had AF, mean age 80.3 (7.8) years and 1,233 (63%) were women. Patients with HFpEF and AF were older, female, greater valvular aetiology and lower comorbidity measured by the Charlson index. At the one year follow-up, 430 (22%) patients had died and 840 (43%) had been readmitted. In the 2 groups analysed, there was no difference in all-cause mortality (22 vs. 21%; P=.739, AF vs. no-AF, respectively) or cardiovascular causes (9.6 vs. 8.2%; P=.739, AF vs. no-AF, respectively). In the multivariable analysis, factors associated with higher mortality were: age, male, valvular aetiology, uric acid, and comorbidity. In the analysis of the subgroup with HFpEF with AF, the presence of chronic AF compared to de novo AF was associated with higher mortality (HR 1,716; 95% CI 1,099-2,681; P=.018).

CONCLUSIONS:

In patients with HFpEF, the presence of AF is frequent. During the one-year follow-up, the presence of AF does not influence mortality or readmissions in patients with HFpEF.

KEYWORDS:

Atrial fibrillation; Fibrilación auricular; Fracción de eyección preservada; Heart failure; Hospital readmission; Insuficiencia cardiaca; Mortalidad; Mortality; Preserved ejection fraction; Reingreso

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