Heart Failure and Other Outcomes in Patients with Atrial Fibrillation by Heart Failure Phenotype

Abstract

Objectives: To assess heart failure(HF) outcomes, according to HF history and HF phenotypes, and compare these events with stroke/systemic embolic events(SEE) and major bleeding(MB), among patients with atrial fibrillation (AF).BackgroundThe risk of HF events compared to SEE or MB by HF phenotypes (reduced ejection fraction (HFrEF) or preserved EF (HFpEF)), in a large AF population, has not been well-studied.

Methods: We analyzed patients enrolled in the ENGAGE-AF TIMI48 trial. Cumulative incidence of HF hospitalization(HHF) or HF death was assessed and compared to the rates of fatal and non-fatal stroke/SEE and MB, over a median follow-up of 2.8 years.

Results: Overall, 12124(57.4%) had a history of HF(37.7%HFrEF, 40.1%HFpEF, 22.1% with unknown EF). The annualized rate of HHF or HF death (4.95%,95%confidence interval (CI):4.70%-5.20%) was higher than of fatal and non-fatal stroke/SEE (1.77%,95%CI:1.63%-1.92%) and MB (2.66%,95%CI:2.63%-3.10%) among patients with HF history. HFrEF patients experienced a higher rate of HHF or HF death compared with HFpEF (7.15% vs. 3.65%, p<0.001), while the rates of fatal and non-fatal stroke/SEE and MB were similar by HF phenotype. Patients with HF history had a higher rate of mortality after a HHF (1.29%,95%CI:1.17%-1.42%) than after a stroke/SEE (0.69%,95%CI:0.60%-0.78%) or after a MB (0.61%,95%CI:0.53%-0.70%).

Conclusion: Patients with AF and HF, regardless of EF, are at a higher risk of HF events with higher subsequent mortality rates than of stroke/SEE or MB. While HFrEF is associated with a higher risk of HF events than HFpEF, the risk of stroke/SEE and MB is similar between HFrEF and HFpEF.

Keywords: Atrial fibrillation, Heart failure, stroke/systemic embolic events, major bleeding