University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK.
Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
Eur J Heart Fail. 2015 Jun;17(6):570-82. doi: 10.1002/ejhf.254. Epub 2015 Mar 2.
The purpose of this study was too describe the associated baseline features of AF patients with heart failure (HF) with reduced and preserved ejection fraction (HFrEF and HFpEF). Secondly, we assessed symptomatic status and their clinical correlates. Finally, we examined independent predictors for 'heart failure' at the 1-year follow-up period.
A survey of European cardiologists from nine countries, participating in the EURObservational Research Programme Pilot survey on Atrial Fibrillation (EORP-AF Pilot), was carried out. Of the whole cohort of 2972 patients, 1411 (47.5%) had a diagnosis of HF. Of the AF patients with HF, oral anticoagulants were prescribed to 82.1% and antiarrhythmic drugs in 36.7%. Independent predictors of HFpEF were high body mass index, high heart rate, high systolic blood pressure, low diastolic blood pressure, high CHA2DS2-VASc score, and absence of chronic kidney disease, sleep apnoea, or ischaemic cardiomyopathy. On multivariate stepwise regression analysis, independent predictors of the development of HF were mode of AF presentation, diuretic use, prior HF, COPD, and valvular disease. At 1 year, HF was associated with a greater risk of all-cause mortality (log-rank test, P < 0.001). When HFrEF was compared with HFpEF at 1 year, crude rates were significant for the composite endpoint of 'stroke/thrombo-embolism/transient ischaemic attack and death' (15.9% vs. 11.1%, P = 0.043).
We provide insights into the clinical characteristics and outcomes in AF patients with HF, who were managed by European cardiologists. Despite a high prevalence of oral anticoagulant use, 1-year mortality and morbidity remained high in AF patients with HF, whether HFrEF or HFpEF. Such patients require a holistic approach to cardiovascular risk management.
本研究旨在描述射血分数降低（HFrEF）和射血分数保留（HFpEF）心力衰竭（HF）的 AF 患者的相关基线特征。其次，我们评估了症状状态及其临床相关性。最后，我们检查了 1 年随访期间“心力衰竭”的独立预测因素。
对来自 9 个国家的 2972 名患者进行了一项欧洲心脏病专家的调查，这些患者参加了 EURObservational Research Programme Pilot 心房颤动（EORP-AF Pilot）调查。在整个 AF 合并 HF 患者队列中，有 1411 例（47.5%）诊断为 HF。在 AF 合并 HF 的患者中，82.1%的患者开具了口服抗凝剂，36.7%的患者开具了抗心律失常药物。HFpEF 的独立预测因素是高体重指数、高心率、高收缩压、低舒张压、高 CHA2DS2-VASc 评分以及无慢性肾脏病、睡眠呼吸暂停或缺血性心肌病。多元逐步回归分析显示，HF 发生的独立预测因素是 AF 发作模式、利尿剂使用、既往 HF、COPD 和瓣膜病。在 1 年时，HF 与全因死亡率增加相关（对数秩检验，P < 0.001）。在 1 年时，将 HFrEF 与 HFpEF 进行比较时，“中风/血栓栓塞/短暂性脑缺血发作和死亡”的复合终点的粗发生率有显著差异（15.9%比 11.1%，P = 0.043）。
我们提供了有关欧洲心脏病专家管理的 AF 合并 HF 患者的临床特征和结局的见解。尽管口服抗凝剂的使用率较高，但 AF 合并 HF 患者的 1 年死亡率和发病率仍然较高，无论是 HFrEF 还是 HFpEF。此类患者需要采取整体方法进行心血管风险管理。
