TY - JOUR
T1 - The Relationship Between Atrial Fibrillation, Mitral Regurgitation, and Heart Failure Subtype
T2 - The ARIC Study
AU - Arora, Sameer
AU - Brown, Zachary D.
AU - Sivaraj, Krishan
AU - Hendrickson, Michael J.
AU - Mazzella, Anthony J.
AU - Chang, Patricia P.
AU - Vaduganathan, Muthiah
AU - Qamar, Arman
AU - Gehi, Anil K.
AU - Pandey, Ambarish
AU - Vavalle, John P.
N1 - Funding Information:
Supported in whole or in part with Federal funds from the National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, under Contract nos. HHSN268201700001I, HHSN268201700002I, HHSN268201700003I, HHSN268201700005I, and HHSN268201700004I.
Funding Information:
Dr. Vaduganathan has received research grant support or served on advisory boards for American Regent, Amgen, AstraZeneca, Bayer AG, Baxter Healthcare, Boehringer Ingelheim, Cytokinetics, Lexicon Pharmaceuticals, Novartis, Pharmacosmos, Relypsa, Roche Diagnostics, and Sanofi, speaker engagements with Novartis and Roche Diagnostics, and participates on clinical endpoint committees for studies sponsored by Galmed and Novartis. Dr Gehi is supported by research funding from the Bristol Myers Squib Foundation, and performs consultation for, and receives speaker's honoraria from, Zoll Medical and Abbott. The rest of the authors have no disclosures.
Publisher Copyright:
© 2021 Elsevier Inc.
PY - 2021
Y1 - 2021
N2 - Background: Atrial fibrillation (AF) and mitral regurgitation (MR) are closely interrelated in the setting of heart failure (HF). Here we investigate the prevalence and prognostic significance of AF in patients with acute decompensated HF (ADHF) stratified by MR severity. Methods and Results: The Atherosclerosis Risk in Communities Study investigated ADHF hospitalizations in residents greater than or equal to 55 years of age in 4 US communities. ADHF cases were stratified by MR severity (none/mild or moderate/severe) and HF subtype (HF with reduced [HFrEF] or preserved [HFpEF] ejection fraction). The odds of AF in patients with increasing MR severity was estimated using multivariable logistic regression, adjusting for age, race, sex, diabetes, hypertension, coronary artery disease, hemodialysis, stroke, and anemia. Cox regression models were used to assess the association of AF with 1-year mortality in patients with HFpEF and HFrEF, stratified by MR severity and adjusted as described, also adjusting for the year of hospitalization. From 2005 to 2014, there were 3,878 ADHF hospitalizations (17,931 weighted). AF was more likely in those with higher MR severity regardless of HF subtype; more so in HFpEF (odds ratio [OR] 1.38, 95% confidence interval [CI], 1.31–1.45) than in HFrEF (OR, 1.19, 95% CI, 1.13–1.25) (interaction P [by HF subtype] < .01). When stratified by HF type, association between AF and 1-year mortality was noted in patients with HFpEF (OR, 1.28, 95% CI 1.04–1.56) but not HFrEF (OR 0.96, 95% CI 0.79–1.16) (interaction by EF subtype, P = .02). Conclusions: In patients with ADHF, AF prevalence increased with MR severity and this effect was more pronounced in HFpEF compared with HFrEF. AF was associated with an increased 1-year mortality only in patients with HFpEF and concomitant moderate/severe MR. Registration: NCT00005131, https://clinicaltrials.gov/ct2/show/NCT00005131
AB - Background: Atrial fibrillation (AF) and mitral regurgitation (MR) are closely interrelated in the setting of heart failure (HF). Here we investigate the prevalence and prognostic significance of AF in patients with acute decompensated HF (ADHF) stratified by MR severity. Methods and Results: The Atherosclerosis Risk in Communities Study investigated ADHF hospitalizations in residents greater than or equal to 55 years of age in 4 US communities. ADHF cases were stratified by MR severity (none/mild or moderate/severe) and HF subtype (HF with reduced [HFrEF] or preserved [HFpEF] ejection fraction). The odds of AF in patients with increasing MR severity was estimated using multivariable logistic regression, adjusting for age, race, sex, diabetes, hypertension, coronary artery disease, hemodialysis, stroke, and anemia. Cox regression models were used to assess the association of AF with 1-year mortality in patients with HFpEF and HFrEF, stratified by MR severity and adjusted as described, also adjusting for the year of hospitalization. From 2005 to 2014, there were 3,878 ADHF hospitalizations (17,931 weighted). AF was more likely in those with higher MR severity regardless of HF subtype; more so in HFpEF (odds ratio [OR] 1.38, 95% confidence interval [CI], 1.31–1.45) than in HFrEF (OR, 1.19, 95% CI, 1.13–1.25) (interaction P [by HF subtype] < .01). When stratified by HF type, association between AF and 1-year mortality was noted in patients with HFpEF (OR, 1.28, 95% CI 1.04–1.56) but not HFrEF (OR 0.96, 95% CI 0.79–1.16) (interaction by EF subtype, P = .02). Conclusions: In patients with ADHF, AF prevalence increased with MR severity and this effect was more pronounced in HFpEF compared with HFrEF. AF was associated with an increased 1-year mortality only in patients with HFpEF and concomitant moderate/severe MR. Registration: NCT00005131, https://clinicaltrials.gov/ct2/show/NCT00005131
KW - Atrial fibrillation
KW - heart failure
KW - mitral regurgitation
KW - mortality
UR - http://www.scopus.com/inward/record.url?scp=85121775303&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85121775303&partnerID=8YFLogxK
U2 - 10.1016/j.cardfail.2021.10.015
DO - 10.1016/j.cardfail.2021.10.015
M3 - Article
C2 - 34955335
AN - SCOPUS:85121775303
SN - 1071-9164
JO - Journal of Cardiac Failure
JF - Journal of Cardiac Failure
ER -