Atrial fibrillation begets heart failure and vice versa: Temporal associations and differences in preserved versus reduced ejection fraction

Rajalakshmi Santhanakrishnan, Na Wang, Martin G. Larson, Jared W. Magnani, David D. McManus, Steven A. Lubitz, Patrick T. Ellinor, Susan Cheng, Ramachandran S. Vasan, Douglas S. Lee, Thomas J. Wang, Daniel Levy, Emelia J. Benjamin, Jennifer E. Ho

Research output: Contribution to journalArticle

188 Scopus citations

Abstract

Background - Atrial fibrillation (AF) and heart failure (HF) frequently coexist and together confer an adverse prognosis. The association of AF with HF subtypes has not been well described. We sought to examine differences in the temporal association of AF and HF with preserved versus reduced ejection fraction. Methods and Results - We studied Framingham Heart Study participants with new-onset AF or HF between 1980 and 2012. Among 1737 individuals with new AF (mean age, 75±12 years; 48% women), more than one third (37%) had HF. Conversely, among 1166 individuals with new HF (mean age, 79±11 years; 53% women), more than half (57%) had AF. Prevalent AF was more strongly associated with incident HF with preserved ejection fraction (multivariable-adjusted hazard ratio [HR], 2.34; 95% confidence interval [CI], 1.48-3.70; no AF as referent) versus HF with reduced ejection fraction (HR, 1.32; 95% CI, 0.83-2.10), with a trend toward difference between HF subtypes (P for difference=0.06). Prevalent HF was associated with incident AF (HR, 2.18; 95% CI, 1.26-3.76; no HF as referent). The presence of both AF and HF portended greater mortality risk compared with neither condition, particularly among individuals with new HF with reduced ejection fraction and prevalent AF (HR, 2.72; 95% CI, 2.12-3.48) compared with new HF with preserved ejection fraction and prevalent AF (HR, 1.83; 95% CI, 1.41-2.37; P for difference=0.02). Conclusions - AF occurs in more than half of individuals with HF, and HF occurs in more than one third of individuals with AF. AF precedes and follows HF with both preserved and reduced ejection fraction, with some differences in temporal association and prognosis. Future studies focused on underlying mechanisms of these dual conditions are warranted.

Original languageEnglish (US)
Pages (from-to)484-492
Number of pages9
JournalCirculation
Volume133
Issue number5
DOIs
StatePublished - Feb 2 2016
Externally publishedYes

Keywords

  • atrial fibrillation
  • epidemiology
  • heart failure
  • mortality
  • ventricular function, left

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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  • Cite this

    Santhanakrishnan, R., Wang, N., Larson, M. G., Magnani, J. W., McManus, D. D., Lubitz, S. A., Ellinor, P. T., Cheng, S., Vasan, R. S., Lee, D. S., Wang, T. J., Levy, D., Benjamin, E. J., & Ho, J. E. (2016). Atrial fibrillation begets heart failure and vice versa: Temporal associations and differences in preserved versus reduced ejection fraction. Circulation, 133(5), 484-492. https://doi.org/10.1161/CIRCULATIONAHA.115.018614