Valente Valeria, Ferrannini Giulia, Benson Lina, Gatti Paolo, Guidetti Federica, Melin Michael, Braunschweig Frieder, Linde Cecilia, Dahlström Ulf, Lund Lars H, Fudim Marat, Savarese Gianluigi
Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
Internal Medicine Unit, Södertälje Hospital, Södertälje, Sweden.
Eur J Heart Fail. 2025 Feb;27(2):236-248. doi: 10.1002/ejhf.3402. Epub 2024 Aug 1.
Heart 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.
We 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).
Atrial 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.
心力衰竭（HF）和心房颤动（AF）常同时存在。我们探讨了射血分数（EF）范围内有HF和无HF患者的AF发病率、患病率及治疗策略。
我们分析了瑞典心力衰竭登记处（2005年12月1日至2021年12月31日）的HF患者，按性别、年龄和居住县与瑞典统计局的无HF患者进行1:1匹配。得出两个研究队列：（i）评估AF患病率和治疗情况；（ii）评估AF发病率及相关预测因素。总体而言，共纳入195106例患者，其中50%患有HF（其中54%为射血分数降低的HF [HFrEF]，23%为轻度降低的HF [HFmrEF]，23%为射血分数保留的HF [HFpEF]）。2006年至2021年期间，有HF患者（从57%升至58%）和无HF患者（从8%升至11%）的AF患病率均有所上升。HF患者，尤其是HFrEF患者，比无HF患者更有可能接受AF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的使用以及与AF相关的手术增加，无论是否患有HF及EF情况如何。在中位随访3.7年期间，在86210例无AF的患者中，HF患者发生AF的风险是无HF患者的两倍（风险比[HR] 2.76，95%置信区间[CI] 2.45 - 3.12），在HFpEF患者中最高（HR 3.12，95% CI 2.65 - 3.67），而HFrEF患者中为（HR 2.68，95% CI 2.34 - 3.06），HFmrEF患者中为（HR 2.53，95% CI 2.17 - 2.94）。
无论是否患有HF，心房颤动患病率、抗凝药使用及与AF相关的手术均随时间增加，HF患者更有可能接受AF治疗。在HF中，尽管HFpEF患者的AF患病率和发病率较高，但AF治疗的使用仍然较少，需要进一步推广。
