Atrial fibrillation and concomitant heart failure with preserved, mid-range, and reduced ejection fraction: results of the Russian observational survey

Mar 28, 2019 Cardiotool Novità Fibrillazione Atriale Commenti disabilitati su Atrial fibrillation and concomitant heart failure with preserved, mid-range, and reduced ejection fraction: results of the Russian observational survey

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TERESHCHENKO S.N., ZHIROVI.V., SAFRONOVA N.V., OSMOLOVSKAYA Yu.F.

National medical research center of cardiology of the Ministry of healthcare of the Russian Federation, 121552, Moscow, 3rd Cherepkovskaya St., house 15A

Background: Heart failure (HF) and atrial fibrillation (AF) are the most common cardiovascular conditions in clinical practice and frequently coexist. There is a gap in understanding of the clinical pattern of HF and AF comorbidity and in selection of the optimal treatment strategies. Aim: To evaluate clinical outcomes of patients with atrial fibrillation and concomitant heart failure with preserved, mid-range, and reduced ejection fraction at 12-month follow-up.
Methods: In multicenter prospective observational study was recruited 1003 patients with heart failure and atrial fibrillation between February 2015 and January 2016. Patients were enrolled to participate in the survey at 30 medical centers in 21 provinces of the Russian Federation and followed up at 12 months. All patients had ECG-documented diagnosis of atrial fibrillation and heart failure with preserved (AF-HFpEF), mid-range (AF-HFmrEF) or reduced (AF-HFrEF) ejection fraction. Patients with ejection fraction ≥40% were eligible for study if they had level of BNP or NT-proBNP larger then100 pg/ml or 300 pg/ml, respectively.
Results: Almost half of patients (46.5%) had AF-HFrEF; 38.6 and 15% of patients had AF-HFpEF and AF-HFmrEF ejection fractions, respectively. Patients with preserved ejection fraction were significantly older and more often women. During the one-year follow-up, 574 (57.2%) patients were hospitalized due to worsening heart failure at least once. The most frequency of HF hospitalization was observed in the AF-HFmrEF group (66%). AF-HFrEF associated with significantly higher cardiovascular mortality rate, 4.1, 9.3 and 15.5% in the AF-HFpEF, AF-HFmrEF, and AF-HFrEF groups, respectively (p<0.001). The rate of all thromboembolic events in the total cohort was 3.4%; the rate of ischemic stroke was 2.7%. The groups were comparable in the rate of thromboembolic events (p=0.451).
Conclusions: Our data shows that reduced ejection fraction increases the risk of cardiovascular mortality but not the risk of thromboembolic events (such as stroke and systemic embolism).
Trial registration: NCT02790801

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