Clinical characteristics and prognostic impact of atrial fibrillation in patients with chronic heart failure

Table 1 Characteristics of study population by presence of atrial fibrillation or sinus rhythm at baseline

	Atrial fibrillation (n = 173)	Sinus rhythm (n = 730)	P value
Demographics and physical examination
Age (yr)	72 ± 11	66 ± 12	< 0.0001
Age ≥ 65 yr (%)	81	60	< 0.0001
Male gender (%)	70	73	0.42
SBP (mmHg)	127 ± 18	130 ± 19	0.10
DBP (mmHg)	74 ± 10	75 ± 10	0.47
NYHA II-III (%)	60	44	0.0002
Aetiology
CAD (%)	28	52	< 0.0001
Previous CABG/PCI (%)	21	37	< 0.0001
Without CAD (%)	22	24	0.58
Others/idiopathic (%)	50	24	< 0.0001
Valve surgery (%)	13	4	< 0.0001
Device
Any PM (%)	30	19	0.001
CRT-P/CRT-D (%)	10	7	0.14
ICD (%)	11	16	0.07
Any device (%)	31	21	0.005
History of VT (%)	2	5	0.06
Risk factors
Hypertension (%)	61	60	0.81
Diabetes mellitus (%)	24	28	0.39
Dyslipidaemia (%)	23	37	0.0004
Ever smoke (%)	27	41	0.0010
Comorbidities
Cancer history (%)	12	10	0.47
COPD (%)	14	13	0.55
Anaemia (%)	6	10	0.11
CKD (eGFR < 60) (%)	7	8	0.57
ECG
Heart rate (bpm)	80 ± 19	70 ± 13	< 0.0001
PM stimulation (%)	24	8	< 0.0001
Right bundle branch block (%)	7	5	0.65
Left bundle branch block (%)	9	16	0.01
Echocardiogram
Preserved LVEF (> 45%) (%)	29	21	0.022
LVEF (%)	38 ± 14	35 ± 12	0.05
Medications
Beta-blockers (%)	72	80	0.01
ACEi/ARB (%)	71	79	0.02
Beta-blockers and ACEi/ARB (%)	51	66	0.0003
Aldosterone blockers (%)	46	37	0.02
Diuretics (%)	87	69	< 0.0001
Calcium channel blockers (%)	6	13	0.01
Alfa-blockers (%)	6	8	0.55
Digoxin (%)	51	11	< 0.0001
Statin (%)	28	49	< 0.0001
Amiodarone (%)	6	13	0.01
Antithrombotic treatment (%)	19	63	< 0.0001
OAT (%)	82	16	< 0.0001
DAPT (%)	2	16	< 0.0001
OAT and antithrombotic (%)	8	2	0.0006
Antithrombotic only (%)	11	61	< 0.0001

SBP: Systolic blood pressure; DBP: Diastolic blood pressure; NYHA: New York Heart Association; CAD: Coronary artery disease; CABG: Coronary artery bypass grafting; PCI: Percutaneous coronary intervention; PM: Pacemaker; CRT-P/D: Cardiac resynchronization therapy pacing/defibrillator; ICD: Internal cardioverter defibrillator; VT: Ventricular tachycardia; COPD: Chronic obstructive pulmonary disease; CKD: Chronic kidney disease; eGFR: Estimated glomerular filtration rate (obtained by CKD-EPI formula); LVEF: Left ventricular ejection fraction; ACEi: ACE inhibitors; ARB: Angiotensin receptor blockers; OAT: Oral anticoagulant treatment; DAPT: Dual anti-platelet therapy.

Table 2 Characteristics of study population by survival or death

	Death (n = 324)	Alive (n = 579)	P value	HR (95%CI)	P value
Atrial fibrillation (%)	23	16	0.0085	1.48 (1.14-1.92)	0.0028
Demographics and physical examination
Age (yr)	71 ± 10	66 ± 12	< 0.0001	1.05 (1.04-1.06)	< 0.0001
Male gender (%)	25	29	< 0.0001	2.4 (1.85-3.07)	< 0.0001
SBP (mmHg, 10)	127 ± 19	130 ± 19	0.0238	0.93 (0.88-0.99)	0.0228
DBP (mmHg, 10)	72 ± 10	76 ± 10	< 0.0001	0.76 (0.67-0.85)	< 0.0001
NYHA II-III (%)	60	40	< 0.0001	1.7 (1.35-2.10)	< 0.0001
Aetiology
CAD (%)	51	46	0.18
Previous CABG/PCI (%)	33	35	0.57
Without CAD (%)	17	27	0.0002	0.53 (0.4-0.71)	< 0.0001
Others/idiopathic	32	26	0.049	1.29 (1.02-1.63)	0.0302
Valve surgery (%)	5	6	0.57
Device
Any PM (%)	28	17	0.0003	1.64 (1.29-2.1)	< 0.0001
CRT-P/CRT-D (%)	8	7	0.32
ICD (%)	20	13	0.0027	1.45 (1.1-1.9)	0.0074
Any device (%)	29	19	0.0006	1.57 (1.23-2.00)	0.0002
History of VT (%)	7	4	0.0258	1.53 (1.01-2.32)	0.0439
Risk factors
Hypertension (%)	58	61	0.2619
Diabetes mellitus (%)	32	24	0.0053	1.72 (1.36-2.17)	< 0.0001
Dyslipidaemia (%)	27	39	0.0003	0.68 (0.53-0.87)	0.0023
Ever smoke (%)	32	41	0.0055	0.92 (0.72-1.16)	0.4668
Comorbidities
Cancer history (%)	14	8	0.0044	1.89 (1.37-2.60)	< 0.0001
COPD (%)	18	10	0.0006	1.84 (1.4-2.40)	< 0.0001
Anaemia (%)	11	8	0.0521	2.22 (1.57-3.13)	< 0.0001
CKD (eGFR < 60) (%)	10	6	0.0551	2.807 (1.85-4.25)	< 0.0001
ECG
Heart rate (bpm, 10)	72 ± 15	70 ± 15	0.1026	1.06 (0.99-1.14)	0.0805
PM stimulation (%)	14	9	0.0438	1.56 (1.14-2.14)	0.0057
Right bundle branch block (%)	7	5	0.0866	1.38 (0.9-2.1)	0.1321
Left bundle branch block (%)	12	16	0.0761	0.75 (0.53-1.05)	0.0958
Echocardiogram
Preserved LVEF (> 45%) (%)	19	24	0.0560	0.74 (0.56-0.98)	0.0345
LVEF (%)	34 ± 12	36 ± 11	0.0015	0.98 (0.97-0.99)	0.0008
Medications
Beta-blockers (%)	72	82	0.0003	0.67 (0.53-0.85)	0.0012
ACEi/ARB (%)	75	79	0.0994	0.69 (0.53-0.88)	0.0032
Beta-blockers and ACEi/ARB (%)	32	68	0.003	0.66 (0.53-0.83)	0.0002
Aldosterone blockers (%)	45	35	0.0033	1.57 (1.26-1.95)	< 0.0001
Diuretics (%)	82	67	< 0.0001	2.50 (1.87-3.31)	< 0.0001
Calcium channel blockers (%)	14	11	0.1588
Alfa-blockers (%)	8	7	0.8049
Digoxin (%)	26	14	< 0.0001	1.60 (1.25-2.05)	0.0002
Statin (%)	39	48	0.0088	0.80 (0.64-1.00)	0.0513
Amiodarone (%)	12	12	0.8421
Antithrombotic treatment (%)	56	54	0.5669
OAT (%)	31	27	0.2374
DAPT (%)	10	15	0.0282	0.89 (0.62-1.29)	0.5394
OAT and antithrombotic (%)	3	4	0.4946
Antithrombotic only (%)	53	50	0.4149

SBP: Systolic blood pressure; DBP: Diastolic blood pressure; NYHA: New York Heart Association; CAD: Coronary artery disease; CABG: Coronary artery bypass grafting; PCI: Percutaneous coronary intervention; PM: Pacemaker; CRT-P/D: Cardiac resynchronization therapy pacing/defibrillator; ICD: Internal cardioverter defibrillator; VT: Ventricular tachycardia; COPD: Chronic obstructive pulmonary disease; CKD: Chronic kidney disease; eGFR: Estimated glomerular filtration rate (obtained by CKD-EPI formula); LVEF: Left ventricular ejection fraction; ACEi: ACE inhibitors; ARB: Angiotensin receptor blockers; OAT: Oral anticoagulant treatment; DAPT: Dual anti-platelet therapy.

Table 3 Univariate and multivariate predictors of all-cause mortality

	Univariate		Multivariate full		Multivariate reduced
	HR (95%CI)	P value	HR (95%CI)	P value	HR (95%CI)	P value
Atrial fibrillation	1.48 (1.14-1.92)	0.0028	0.98 (0.73-1.32)	0.8896
Age (1 yr)	1.05 (1.04-1.06)	< 0.0001	1.04 (1.03-1.05)	< 0.0001	1.04 (1.03-1.05)	< 0.0001
Male gender	2.4 (1.85-3.07)	< 0.0001	1.45 (1.11-1.90)	0.0068	1.48 (1.13-1.93)	0.0045
SBP (10 mmHg)	0.93 (0.88-0.99)	0.0228	0.92 (0.86-0.98)	0.0084	0.91 (0.86-0.97)	0.0057
NYHA II-III	1.70 (1.35-2.10)	< 0.0001	1.3 (1.03-1.65)	0.0265	1.32 (1.05-1.66)	0.0195
Without CAD	0.53 (0.4-0.71)	< 0.0001	0.61 (0.44-0.84)	0.0023	0.58 (0.43-0.80)	0.0008
Any device	1.57 (1.23-2.00)	0.0002	1.65 (1.19-2.29)	0.0028	1.57 (1.23-2.02)	0.0004
Dyslipidaemia	0.68 (0.53-0.87)	0.002	0.8 (0.60-1.06)	0.1151
Diabetes mellitus	1.72 (1.36-2.17)	< 0.0001	1.63 (1.27-2.08)	0.0001	1.59 (1.25-2.04)	0.0002
Cancer history	1.89 (1.37-2.60)	< 0.0001	1.82 (1.31-2.54)	0.0004	1.84 (1.33-2.56)	0.0003
COPD	1.84 (1.4-2.4)	< 0.0001	1.33 (0.98-1.80)	0.0707	1.38 (1.02-1.86)	0.0359
Anaemia	2.22 (1.57-3.13)	< 0.0001	1.82 (1.23-2.69)	0.0027	1.95 (1.37-2.79)	0.0002
CKD (eGFR < 60)	2.81 (1.85-4.25)	< 0.0001	1.42 (0.87-2.29)	0.1577
Preserved LVEF (> 45%)	0.74 (0.56-0.98)	0.034	0.91 (0.68-1.22)	0.5369
PM stimulation	1.56 (1.14-2.14)	0.006	0.91 (0.59-1.40)	0.6561
Beta-blockers	0.67 (0.53-0.85)	0.001	0.83 (0.64-1.09)	0.1903
ACEi/ARB	0.69 (0.53-0.88)	0.003	0.77 (0.59-1.01)	0.0634	0.73 (0.56-0.94)	0.0169
Aldosterone blockers	1.57 (1.26-1.95)	< 0.0001	1.11 (0.86-1.43)	0.429
Diuretics	2.5 (1.87-3.31)	< 0.0001	1.51 (1.09-2.10)	0.0134	1.58 (1.17-2.15)	0.0031
Digoxin	1.6 (1.25-2.05)	0.0002	1.29 (0.97-1.73)	0.0807	1.31 (1.00-1.72)	0.0482
Statin	0.8 (0.64-1.00)	0.051	0.8 (0.60-1.05)	0.1108	0.71 (0.55-0.90)	0.0057

Any device included any pacemaker or internal-cardioverter defibrillator. SBP: Systolic blood pressure; NYHA: New York Heart Association; CAD: Coronary artery disease; COPD: Chronic obstructive pulmonary disease; CKD: Chronic kidney disease; eGFR: Estimated glomerular filtration rate by CKD-EPI formula; LVEF: Left ventricular ejection fraction; PM: Pacemaker; ACEi: ACE inhibitors; ARB: Angiotensin receptor blocker.