Heart failure
Recent Trends in the Incidence, Treatment, and Prognosis of Patients With Heart Failure and Atrial Fibrillation (the Worcester Heart Failure Study)

https://doi.org/10.1016/j.amjcard.2013.01.298Get rights and content

Atrial fibrillation (AF) and heart failure (HF) are common cardiovascular diseases and the co-occurrence of AF and HF has been associated with reduced survival. Data are needed on the potentially changing trends in the characteristics, treatment, and prognosis of patients with acute decompensated HF (ADHF) and AF. The study population consisted of 9,748 patients hospitalized with ADHF at 11 hospitals in the Worcester, Massachusetts, metropolitan area during 4 study years (1995, 2000, 2002, and 2004). Of the 9,748 patients admitted with ADHF, 3,868 (39.7%) had a history of AF and 449 (4.6%) developed new-onset AF during hospitalization. The rates of new-onset AF remained stable (4.9% in 1995; 5.0% in 2004), but the proportion of patients with pre-existing AF (34.5% in 1995; 41.6% in 2004) increased over time. New-onset and pre-existing AF were associated with older age, but pre-existing AF was more closely linked to a greater co-morbid disease burden. The use of HF therapies did not differ greatly by AF status. Despite this, new-onset AF was associated with a longer length of stay (7.5 vs 6.1 days) and greater in-hospital death rates (11.4% vs 6.6%). In contrast, pre-existing AF was associated with lower rates of postdischarge survival compared to patients with no AF (p <0.05 for all). The mortality rates improved significantly over time in patients with AF. In conclusion, AF was common among patients with ADHF, and the proportion of ADHF patients with co-occurring AF increased during the study period. Despite improving trends in survival, patients with ADHF and AF are at increased risk of in-hospital and postdischarge mortality.

Section snippets

Methods

The Worcester Heart Failure Study is a community-based investigation of adult residents from the Worcester, Massachusetts, metropolitan area (2000 census population estimates 478,000) who were hospitalized for ADHF at any of the 11 greater Worcester medical centers during 4 study years (1995, 2000, 2002, and 2004). Primary and/or secondary “International Classification of Diseases” discharge diagnoses consistent with possible HF were reviewed in a standardized fashion, as previously outlined in

Results

The mean age of the study participants was 76.2 years, 56.1% were women, and 93.3% were white. Of the 9,748 patients admitted with ADHF from 1995 to 2004, 3,868 patients (39.7%) had a history of AF and 449 (4.6%) developed new-onset AF during hospitalization (Table 1). Greater rates of new-onset AF were observed in patients without a history of HF (7.0% vs 3.6%).

The rates of new-onset AF remained stable from 1995 to 2004 (4.9% to 5.0%), and the proportion of patients with pre-existing AF (34.5%

Discussion

Within a community-based cohort of almost 10,000 patients hospitalized with ADHF during a nearly decade-long period, we have demonstrated that pre-existing and new-onset AF are common in these ill patients and that the proportion of patients hospitalized with pre-existing AF and HF is increasing.

AF and HF frequently coexist and have similar risk factors, with each condition predisposing to the other.21 Estimates on the prevalence of AF among patients hospitalized with AF vary (15% to 35%);

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