Characterizing atrial fibrillation in patients with and without heart failure across the ejection fraction spectrum: Incidence, prevalence, and treatment strategies,European Journal of Heart Failure

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Characterizing atrial fibrillation in patients with and without heart failure across the ejection fraction spectrum: Incidence, prevalence, and treatment strategies
European Journal of Heart Failure ( IF 16.9 ) Pub Date : 2024-08-01 , DOI: 10.1002/ejhf.3402
Valeria Valente ₁ , Giulia Ferrannini _{1,

2} , Lina Benson ₁ , Paolo Gatti _{1,

2} , Federica Guidetti ₁ , Michael Melin _{1,

3} , Frieder Braunschweig _{1,

4} , Cecilia Linde _{1,

4} , Ulf Dahlström ₅ , Lars H Lund _{1,

4} , Marat Fudim _{6,

7} , Gianluigi Savarese ₁

Affiliation

AimsHeart failure (HF) and atrial fibrillation (AF) often coexist. We explored AF incidence, prevalence, and treatment strategies in patients with versus without HF across the ejection fraction (EF) spectrum.Methods and resultsWe analysed patients with HF from the Swedish HF Registry (1 December 2005–31 December 2021), matched 1:1 by sex, age, and county of residence to patients without HF from Statistics Sweden. Two study cohorts were derived (i) to assess AF prevalence and treatments, and (ii) to evaluate AF incidence and related predictors. Overall, 195 106 patients were considered, 50% of them with HF (of whom 54% with HF with reduced [HFrEF], 23% mildly reduced [HFmrEF], and 23% with preserved EF [HFpEF]). From 2006 to 2021, AF prevalence increased in both patients with (57% to 58%) and without HF (8% to 11%). HF patients, particularly if with HFrEF, were more likely receiving AF treatments than those without HF. Over time, antiarrhythmic use decreased, while rate control drugs and oral anticoagulant use, and AF‐related procedures increased, regardless of HF and EF. During a median follow‐up of 3.7 years, in 86 210 patients without AF, incident AF risk was two‐fold higher in HF versus non‐HF (hazard ratio [HR] 2.76, 95% confidence interval [CI] 2.45–3.12), highest in HFpEF (HR 3.12, 95% CI 2.65–3.67) versus HFrEF (HR 2.68, 95% CI 2.34–3.06) and HFmrEF (HR 2.53, 95% CI 2.17–2.94).ConclusionsAtrial fibrillation prevalence, anticoagulant use, and AF‐related procedures increased over time regardless of HF, with HF patients more likely receiving AF treatments. In HF, despite higher AF prevalence and incidence in HFpEF, AF treatment use remained modest, calling for further implementation.

中文翻译：

在射血分数谱范围内描述患有和不患有心力衰竭的患者心房颤动的特征：发生率、患病率和治疗策略

目的心力衰竭（HF）和心房颤动（AF）经常同时存在。我们探讨了射血分数 (EF) 范围内心力衰竭患者与非心力衰竭患者的房颤发生率、患病率和治疗策略。方法和结果我们分析了瑞典心力衰竭登记处的心力衰竭患者（2005 年 12 月 1 日至 2021 年 12 月 31 日），匹配 1： 1 瑞典统计局按性别、年龄和居住县划分的无心力衰竭患者。得出两个研究队列：(i) 评估 AF 患病率和治疗方法，以及 (ii) 评估 AF 发生率和相关预测因素。总体而言，纳入了 195 106 名患者，其中 50% 患有心力衰竭（其中 54% 患有心力衰竭 [HFrEF] 降低，23% 轻度降低 [HFmrEF]，23% 患有保留 EF [HFpEF]）。从 2006 年到 2021 年，患有心力衰竭（57% 至 58%）和不患有心力衰竭（8% 至 11%）的患者中房颤患病率均有所增加。心力衰竭患者，特别是患有 HFrEF 的患者，比没有心力衰竭的患者更有可能接受房颤治疗。随着时间的推移，抗心律失常药物的使用减少，而心率控制药物和口服抗凝药物的使用以及 AF 相关手术增加，无论 HF 和 EF 如何。在中位随访 3.7 年期间，在 86 210 名无房颤的患者中，心力衰竭患者发生房颤的风险是非心力衰竭患者的两倍（风险比 [HR] 2.76，95% 置信区间 [CI] 2.45–3.12），HFpEF（HR 3.12，95% CI 2.65–3.67）与 HFrEF（HR 2.68，95% CI 2.34–3.06）和 HFmrEF（HR 2.53，95% CI 2.17–2.94）相比最高。无论是否存在心力衰竭，房颤相关手术都会随着时间的推移而增加，心力衰竭患者更有可能接受房颤治疗。在 HF 中，尽管 HF 患病率和 HFpEF 发病率较高，但 AF 治疗的使用仍然不多，需要进一步实施。

更新日期：2024-08-01

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