Incidence and Predictors of Heart Failure in Patients with Atrial Fibrillation

Abstract

Abstract Background Heart failure (HF) is a frequent cause of hospitalization and death in patients with atrial fibrillation (AF). Identifying AF patients at risk of HF hospitalization could help select individuals for intensive follow-up and treatment. Methods We pooled data from three randomized trials (ACTIVE, RE-LY and AVERROES) of AF patients, for derivation and internal validation of a risk score for first HF hospitalization. Secondary endpoints were cardiovascular death and a composite of HF hospitalizations and cardiovascular death. Results In 23,503 patients, mean age was 71.3 years and 62% were male. Over a mean follow-up of 2.0 years, 875 (3.7%) patients experienced their first HF hospitalization and 1,037 (4.4%) patients died from cardiovascular causes. Incidence rates per 100 patient years were 1.85 for HF hospitalizations, 2.15 for cardiovascular death and 3.71 for the composite. Independent predictors for HF hospitalizations included: increased age, weight, heart rate and serum creatinine, lower height and systolic blood pressure, diabetes, vascular disease, valvular disease, heart rhythm, left ventricular hypertrophy, and intraventricular conduction delay. The C-statistic (95% confidence intervals by bootstrap simulations) was 0.717 (0.705-0.732). At 2 years of follow-up, the incidence rate of the primary outcome increased across risk score quintiles: 0.49, 0.87, 1.29, 2.44 and 4.51 per 100 patient-years, respectively. Patients in the highest quintile had an absolute risk of 6.8% for the primary endpoint at 2 years. Conclusions In a large AF population, new-onset HF was common. A combination of characteristics can identify high-risk patients where strategies to prevent HF should be considered.