Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
Division of Cardiology and Angiology, Heart Center University of Bochum, Bad Oeynhausen, Germany.
Eur J Prev Cardiol. 2024 Aug 22;31(11):1372-1384. doi: 10.1093/eurjpc/zwae185.
The study investigates the prognosis of atrial fibrillation (AF) in patients with heart failure with mildly reduced ejection fraction (HFmrEF). Data concerning the prognostic impact of AF in patients with HFmrEF is scarce.
Consecutive patients with HFmrEF [i.e. left ventricular ejection fraction 41-49% and signs and/or symptoms of heart failure (HF)] were retrospectively included at one institution from 2016 to 2022. Patients with AF were compared with patients without with regard to the primary composite endpoint of all-cause mortality and HF-related rehospitalization at 30 months (median follow-up). Statistical analyses included Kaplan-Meier, multivariable Cox proportional regression analyses, and propensity score matching. A total of 2148 patients with HFmrEF were included with an overall prevalence of AF of 43%. The presence of AF was associated with a higher risk of the primary composite endpoint all-cause mortality and HF-related rehospitalization at 30 months [hazard ratio (HR) = 2.068; 95% confidence interval (CI) 1.802-2.375; P = 0.01], which was confirmed after propensity score matching (HR = 1.494; 95% CI 1.216-1.835; P = 0.01). AF was an independent predictor of both all-cause mortality (HR = 1.340; 95% CI 1.066-1.685; P = 0.01) and HF-related rehospitalization (HR = 2.061; 95% CI 1.538-2.696; P = 0.01). Finally, rhythm control may be associated with lower risk of all-cause mortality compared with rate control for AF (HR = 0.342; 95% CI 0.199-0.587; P = 0.01).
Atrial fibrillation affects 43% of patients with HFmrEF and represents an independent predictor of adverse long-term prognosis.
本研究旨在探讨射血分数轻度降低的心力衰竭（HFmrEF）患者心房颤动（AF）的预后。关于 HFmrEF 患者中 AF 的预后影响的数据很少。
本研究回顾性纳入了一家机构 2016 年至 2022 年间连续收治的 HFmrEF 患者[即左心室射血分数 41-49%，有心力衰竭（HF）的体征和/或症状]。将 AF 患者与无 AF 患者进行比较，以评估 30 个月（中位随访时间）时全因死亡率和 HF 相关再住院的主要复合终点。统计分析包括 Kaplan-Meier 分析、多变量 Cox 比例风险回归分析和倾向评分匹配。共纳入 2148 例 HFmrEF 患者，其中 AF 总患病率为 43%。AF 的存在与 30 个月时全因死亡率和 HF 相关再住院的主要复合终点风险增加相关[风险比（HR）=2.068；95%置信区间（CI）1.802-2.375；P=0.01]，这一结果在倾向评分匹配后得到了证实（HR=1.494；95%CI 1.216-1.835；P=0.01）。AF 是全因死亡率（HR=1.340；95%CI 1.066-1.685；P=0.01）和 HF 相关再住院（HR=2.061；95%CI 1.538-2.696；P=0.01）的独立预测因素。最后，与节律控制相比，AF 的心率控制可能与较低的全因死亡率风险相关（HR=0.342；95%CI 0.199-0.587；P=0.01）。
AF 影响 43%的 HFmrEF 患者，是不良长期预后的独立预测因素。
