An Analysis Of Risk Factors And Drug Treatment In Patients With Heart Failure With Preserved Ejection Fraction In Combination With Atrial Fibrillation

ObjectiveAt present,the research on the risk factors of heart failure complicated with atrial fibrillation is more based on the understanding of heart failure with reduced ejection fraction(HFr EF)complicated with atrial fibrillation,while there are few studies on heart failure with preserved ejection fraction(HFpEF)complicated with atrial fibrillation.In this study,the clinical data of HFpEF patients with atrial fibrillation were analyzed to explore the clinical related factors and clinical medication characteristics of HFpEF patients with AF.MethodsHeart failure patients with preserved ejection fraction who were hospitalized in the department of cardiology of henan people's hospital from December 2016 to December 2018 were collected and divided into atrial fibrillation group and non-atrial fibrillation group according to whether they had atrial fibrillation or not.Record and analyze major clinical and laboratory data,including gender,age,history of diabetes,hypertension,dyslipidemia,smoking and drinking,etiology of heart failure,heart function grade(NYHA class),systolic blood pressure,diastolic blood pressure,mean arterial pressure,BMI,Level of RDW,ALT,AST,Serum albumin,DBIL,IBIL,SCr,BUN,BUA,serum potassium,TC,TG,HDL-C,LDL-C,HbA1 c,NT-pro BNP,and LVEF,LAD,LVEDD,RAD,RVD were measured by echocardiography.In addition,also includes the medical treatment during the hospital.All statistic were analyzed by SPSS23.0 statisticalsoftware.Mean ± standard deviation(x ±s)was used to describe the measurement data of normal distribution,t-test of two independent samples was used for comparison between groups.Median and quartile spacing were used for measurement data of non-normal distribution.Statistic analysis among groups was performed by mann-whitney U test,the count data groups by chi-square test,and non-parametric test was used for the comparison between the grade data groups.Finally,multivariate Logistic regression analysis was performed to find the independent risk factors P <0.05 indicated that the difference was statistically significant.Results1.According to the general clinical data,there were 142 cases in AF group and 155 cases in N-AF group.The proportion of hypertension(P=0.023),diabetes(P=0.012),dyslipidemia(P < 0.001)and drinking history(P=0.048)in AF group was higher than that in N-AF group,and there was significant difference between the two groups.There was no significant differences in smoking history(P=0.388),systolic blood pressure(P= 0.722),diastolic blood pressure(P=0.267),mean arterial pressure(P=0.725),BMI(P=0.798),age(P= 0.075),male(P= 0.304),ischemic cardiomyopathy(P= 0.475)and cardiac function grade(P=0.682).2.According to the results of laboratory examination,the indicators of TC(P=0.007),TG(P < 0.001),LDL-C(P=0.023),HbA1c(P < 0.001)and NT-pro BNP(P=0.012)in AF group were significantly higher than those in N-AF group,while HDL-C(P < 0.001)in AF group was was significantly lower than that in N-AF group.There was no significant difference in RDW(P=0.762),ALT(P= 0.686),AST(P=0.820),serum albumin(P=0.305),DBIL(P=0.061),IBIL(P=0.286),SCr(P=0.204),BUN(P=0.938),BUA(P=0.157)and serum potassium(P= 0.939)between the two groups.3.According to the results of echocardiography,there was no significant difference in LVEDD(P=0.454),RAD(P=0.862)and LVEF(P=0.098)between AF group and N–AF group,while LAD(P<0.001)and RVD(P=0.010)in AF group were higher than those in N-AF group,and the difference between the two groups was statistically significant.4.There was no significant difference in the use of diuretics(P = 0.591),spironolactone(P = 0.098),statins(P = 0.676),calcium channel blockers(P = 0.810),ACEI/ARB(P = 0.975),beta blockers(P = 0.210)between AF and N-AF groups,while the use of digoxin(P=0.006)and anticoagulant drugs(P < 0.001)in the AF group was significantly higher than that in the N-AF group.5.Multivariate logistic regression analysis showed that LAD(OR=1.090,P < 0.001)and hypertension(OR=1.857,P=0.025)were positively correlated with atrial fibrillation,which were independent risk factors of atrial fibrillation in HFpEF,while HDL-C(OR=0.411,P <0.001)was negatively correlated with atrial fibrillation,which was a protective factor of HFpEF complicated atrial fibrillation.Conclusion1.Alcohol consumption,diabetes,dyslipidemia,TC,TG,HbA1 c,LDL-C,NT-pro BNP and RVD may be the clinical risk factors of HFpEF complicated atrial fibrillation.2.LAD and hypertension are independent risk factors of atrial fibrillation in HFpEF.3.Low levels of HDL-C may increase the risk of HFpEF complicated with atrial fibrillation.4.Anticoagulation and ventricular rate control are common clinical strategies for the treatment of HFpEF complicated with AF.