Association of Heart Failure Subtypes and Atrial fibrillation: Data from the Atherosclerosis Risk in Communities Study Open Access

Nji Aiwokeh Mbong, Miriam (Spring 2020)

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The frequent co-existence of atrial fibrillation (AF) and heart failure (HF) pose a significant public health problem in the US. Data on the association of AF with HF subtypes according to recent criteria has not been previously described in a community-based cohort. This analysis aimed to determine prevalence and incidence of AF among HF subtypes in a biracial community-based cohort.

 A total of 6,496 participants in the Atherosclerosis Risk in Community study (mean age, 75.8±5.3, 58.9% women, 23.4% black) who attended the 5th study visit (2011-2013) were included in this analysis. AF was ascertained from study electrocardiograms, hospital discharges, and death certificates. HF was identified from physician adjudicated diagnosis, hospital discharges, and self-report. HF subtypes were based on echocardiography. A left ventricular ejection fraction <40% represents HF with reduced ejection fraction (HFrEF), 40%-49% for HR with midrange ejection fraction (HFmEF), and ³50% for HF with preserved ejection fraction (HFpEF). Logistic regressions and Cox proportional hazards were used to estimate associations of prevalent and incident AF with HF subtypes. Among eligible participants, 393 had HF (HFpEF=232, HFmEF=41, HFrEF=35 and unclassified HF =85) and 735 had AF. The prevalence of AF was 43.5%, 51.2%, 54.3%, 48.2% and 9.1% among participants with HFpEF, HFmEF, HFrEF, unclassified HF and no HF categories respectively. Compared to no HF, all HF subtypes were more likely to have prevalent AF [HFpEF, OR (95%CI): 7.4 (5.6-9.9); HFmEF OR (95%CI): 8.1 (4.3-15.3); HFrEF, OR (95%CI): 10.0 (5.0-20.2); unclassified HF, OR (95%CI): 8.8 (5.6-14.0))] adjusting for covariates. Subjects who did not have AF at baseline (n=5,761) were followed from 2011 to 2017 and 610 of them developed AF (incidence rates of 19.5, 67.1, 121.6, 106.0 and 66.5 per 1000 person-years for no HF, HFpEF, HFmEF, HFrEF, unclassified HF respectively). Prevalent HF was associated with increased risk of AF [HFpEF, HR (95%CI): 2.3 (1.6-3.3); HFmEF, HR (95%CI): 4.6 (2.4-8.6) HFrEF, HR (95%CI): 3.8 (1.8-8.2); unclassified HF, HR (95%CI): 2.3 (0.9-5.6)], adjusting for baseline covariates.

The frequent co-occurrence of AF and HF underscores the importance of understanding the interplay of these two epidemics and evaluating shared preventive and therapeutic strategies.

Table of Contents

Introduction. 1

Methods. 2

Study population and setting. 2

HF Ascertainment 3

AF Ascertainment 3

Covariates 4

Statistical analysis 5

Results. 7

Association of Prevalent HF subtypes with Prevalent AF. 7

Association of Prevalent HF subtypes with Incident AF. 8

Discussion. 9

References. 12

Appendix: Tables and Figures. 16

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