The Follow-up Analysis Of Clinical Prognosis In Patients With Different Types Of Atrial Fibrillation And Systolic Heart Failure

Background: Atrial fibrillation(AF)and heart failure(HF)have emerged as the main epidemics in the 21 st century due to increasing morbidity and mortality.It is unclear whether AF is an independent predictor of adverse cardiovascular events of patients with heart failure.The association between different types of atrial fibrillation and the prognosis of heart failure has not been widely evaluated.Objectives: The study aimed to investigate the prognostic significance of atrial fibrillation in patients with systolic heart failure and the association between different types of AF and adverse outcomes in patients with systolic heart failure.Methods: The study had collected the clinical data of patients with systolic heart failure who admitted to the department of cardiology in the first Affiliated Hospital of Soochow University from June 1st,2015 to May 30 th,2017.According to inclusion and exclusion criteria and history of AF,patients with systolic heart failure were divided into four groups: non-AF group,paroxysmal AF group,persistent or permanent AF group and new onset AF group.The primary endpoint was defined as a composite of cardiovascular death,HF hospitalization and stroke.Using the patients with non-AF as the control group,the hazard ratio(HR)and 95% confidence interval(95% CI)were calculated by the multivariate Cox proportional hazard models.The Kaplan-Meier survival curve of different groups was also compared.Results: A total of 314 patients with systolic heart failure were included in this study.The follow-up period was 26.6 months.Of the 314 cases,184 reached the primary endpoint,166 occurred HF hospitalization,58 occurred cardiovascular death and 16 occurred stroke.Using the multivariate Cox proportional hazard models with no AF as reference,it was found that AF was an independent risk factor for adverse outcomes in patients with systolic heart failure(HR=1.46,95%CI=1.08-1.96,p=0.013).Compared with patients without AF,the risk of the primary endpoint was higher in patients with paroxysmal AF(Adjusted HR=1.98,95%CI=1.20-3.26,p=0.007).The risks of HF hospitalization(Adjusted HR=2.20,95%CI=1.32-3.68,p=0.003)and stroke(Adjusted HR=5.51,95%CI=1.37-22.08,p=0.016)were also increased.In unadjusted analyses,the risks of the primary endpoint and HF hospitalization were increased in patients with persistent or permanent AF.However,after adjusting the relevant factors,there was no statistically significance in the risk of primary endpoint in patients with persistent or permanent AF.New onset AF was associated with increased risk of adverse outcomes: primary endpoint(HR=2.99,95%CI=1.55-5.78,p=0.001),HF hospitalization(HR=3.70,95%CI=1.91-7.17,p<0.001),cardiovascular death(HR=2.71,95%CI=1.05-7.04,p=0.040),Stroke(HR=12.5,95%CI=3.09-50.15,p<0.001).Conclusions: AF is an independent predictor of adverse cardiovascular events of patients with systolic heart failure.Patients with paroxysmal AF were at increasing risk of HF hospitalization.New onset AF was associated with the significant risk of HF hospitalization,cardiovascular death and stroke.