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Impact of Atrial Fibrillation and Heart Failure, Independent of Each Other and in Combination, on Mortality in Community-Dwelling Older Adults

https://doi.org/10.1016/j.amjcard.2014.05.045Get rights and content

Atrial fibrillation (AF) and heart failure (HF), common in older adults, are associated with poor outcomes. However, little is known about their impact, independent of each other. We studied 5,673 community-dwelling adults aged ≥65 years in the Cardiovascular Health Study. Baseline prevalent AF and HF were centrally adjudicated, and 116 patients had AF only, 219 had HF only, 39 had both, and 5,263 had neither. The Cox proportional hazards model was used to estimate age-gender-race–adjusted hazard ratio (aHR) and 95% confidence intervals (CIs) for all-cause, cardiovascular (CV), and non-CV mortalities. Participants had a mean age of 73 years (±6 years), 58% were women, and 15% African-American. During 13 years of follow-up, all-cause mortality occurred in 43%, 66%, 74%, and 85% of those with neither, AF only, HF only, and both, respectively. Compared with neither, aHR (95% CIs) for all-cause mortality associated with AF only, HF only, and both was 1.36 (1.08 to 1.72), 2.31 (1.97 to 2.71), and 3.04 (2.15 to 4.29), respectively. Similar associations were observed with CV mortality, but HF only also had greater non-CV mortality (aHR 1.72, 95% CI 1.35 to 2.18). Compared with AF alone, aHR (95% CIs) associated with HF alone for all-cause, CV, and non-CV mortalities was 1.69 (1.29 to 2.23), 1.73 (1.20 to 2.51), and 1.64 (1.09 to 2.46), respectively. Compared with HF alone, those with both conditions had greater CV but not all-cause mortality. In conclusion, community-dwelling older adults with AF have greater mortality than those without but lesser than those with HF, and both conditions were associated with greater CV and all-cause mortalities, whereas only those with HF had greater non-CV mortality.

Section snippets

Methods

We used a public-use copy of the Cardiovascular Health Study (CHS) data obtained from the National Heart, Lung and Blood Institute, which also sponsored the study. The CHS is an ongoing, prospective, community-based, epidemiologic study of cardiovascular (CV) disease risk factors among participants aged ≥65 years, the rationale and design of which have been previously reported.7 The 5,888 Medicare-eligible CHS participants were recruited in 2 phases (1989 to 1990 and 1992 to 1993) from 4 US

Results

Participants (n = 5,673) had a mean (±SD) age of 73 years (±6), 58% were women, and 15% were African-American. Compared with those with neither condition, those with both AF and HF were more likely to be women, with lesser income, self-reported poor health, and greater prevalence of CV risk factors (Table 1).

During 13 years of follow-up, all-cause mortality occurred in 43%, 66%, 74%, and 85% of those with neither, AF only, HF only, and both, respectively (Table 2). Compared with the neither

Discussion

Findings from our study demonstrate that among community-dwelling older adults, compared with those without AF or HF, the presence of AF (without HF) was associated with significantly greater all-cause mortality, which was delayed until after the first 6 years of follow-up and was driven by a greater CV mortality. In contrast, those with HF (without AF) had greater all-cause mortality that occurred sooner and was also associated with greater CV and non-CV mortalities, compared with those with

Disclosures

Dr. Ahmed was in part supported by NIH grants R01-HL085561 and R01-HL097047 from the National Heart, Lung, and Blood Institute, Bethesda, Maryland, and an intramural support from the UAB Comprehensive Cardiovascular Center, Birmingham, Alabama. The authors have no conflicts of interest to disclose.

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    Drs. Bajaj and Bhatia contributed equally and are co-primary authors.

    See page 912 for disclosure information.

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