Effect Of Atrial Fibrillation On Clinical Features And 2-year Prognosis Of Heart Failure Patients

Objective: To compare the prevalence,clinical characteristics and prognosis of atrial fibrillation and sinus rhythm in heart failure with preserved ejection fraction(HFp EF),heart failure with mid-range ejection fraction(HFmr EF)and heart failure with reduced ejection fraction(HFr EF).Background: AF and HF are two common cardiovascular diseases,and AF is the most common arrhythmia in HF.There is a complex pathophysiological link between them.The data of researches which involves the effect of AF on the prognosis of HF patients are from HFr EF and HFp EF.Heart failure with ejection fraction between40% and 49% was recently defined as HFmr EF.There is a lack of relevant studies describe the association of atrial fibrillation with HFmr EF,and the differences in clinical characteristics and prognosis of patients with HFr EF、HFp EF are also unclear.Methods: This study was a retrospective cohort study.We use the self-made heart failure questionnaire to collect relevant clinical data of heart failure patients hospitalized in two hospitals from March 2014 to February 2016,and included 2266 patients with chronic heart failure(HF)as the main diagnosis.According to the left ventricular ejection fraction divided into three groups,and then according to whether combined with AF,each group was divided into two subgroups.And assess the prevalence,clinical characteristics and prognostic impact of atrial fibrillation in HFpEF、HFmrEF and HFr EF.Results: Of the 2266 eligible patients,22.2% were HFpEF(502),33.5% were HFmr EF(758)and 44.4% were HFr EF(1006).1)The prevalence of AF in HFp EF 、HFmr EF and HFr EF was respectively 38%,29.4% and 20.5%.2.)In the total HF、HFp EF、HFmr EF、HFr EF,AF group of patients were older and men were more at risk of AF than women.3.)In the total HF,AF group had worse grade of cardiac function,more patients with smoking history,complicated with stroke,more pulmonary infection,and more use of digitalis,aldosterone receptor blockers,and myocardial metabolic drugs(trimetazidine hydrochloride,coenzyme Q10 、 levocarnitine,creatine phosphate,fructose diphosphate,etc.).4.)The clinical characteristics of the AF and SR groups in the HFmr EF、HFp EF were similar to that of the total;however, in the HFmr EF 、HFp EF,the difference between the clinical characteristics of the group and the group was reduced.AF group in the HFr EF had similar clinical characteristics to the total HF and had higher NT-pro BNP levels;in the HFmr EF、HFp EF,there was no significant difference in baseline clinical characteristics between the AF group and the group,but the use of digitalis and drugs to improve myocardial metabolism was higher in the group.5.)After multivariable adjustment,the hazard ratio of AF for HF hospitalizations was 1.64(95% CI:1.28-2.10)in total HF、1.50(95% CI:0.92~2.45)in HFp EF、1.87(95% CI:1.24~2.81)in HFmr EF、1.51(95% CI:1.01~2.26)in HFr EF;for all-cause death :1.02(95% CI:0.79~1.32)in total HF、0.79(95% CI:0.48~1.27)in HFp EF、0.97(95% CI:0.59-1.42)in HFmr EF、1.24(95% CI:0.82-1.87)in HFr EF;and for combined all-cause death or HF hospitalizations: 1.42(95% CI:1.14-1.78)in total HF、 1.25(95% CI:0.80~1.97)in HFp EF、1.37(95% CI:0.94~2.00)in HFmr EF、1.50(95% CI:1.04~2.17)in HFr EF.Conclusion: 1.)In HF patients,the incidence of AF increases with increased ejection fraction.2.)In patients with heart failure,AF patients were older,had a worse grade of NYH cardiac function,and men were higher than women.3.)In the total HF study population,AF combination and stroke,more lung infections,digitalis,aldosterone receptor blockers,improved myocardial metabolic drugs use more.SR group of patients with coronary heart disease,hypertension,diabetes more,ACEI/ARB class,MRAs、 antiplatelet drugs use more.The use of β receptor blockers and diuretics did not differ between the AF and SR groups.4.)The clinical characteristics of the AF and SR groups in the HFmr EF、HFp EF were similar to that of the total;however,in the HFmr EF、HFp EF,the difference between the clinical characteristics of the group and the group was reduced.5.)In the total HF,AF was associated with a higher rate of readmission and complex endpoint events in HF patients,with no significant difference in all-cause mortality from SR.effect of AF on the prognosis of three different types of heart failure is different.