Amiel Pierre J, Ambale-Venkatesh Bharath, Wu Colin O, Matheson Matthew, Ostovaneh Mohammad R, Lima João A C, Cox Christopher F
Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD.
Department of Radiology, Johns Hopkins Hospital, Baltimore, MD.
J Card Fail. 2025 Feb 3. doi: 10.1016/j.cardfail.2025.01.012.
Heart failure (HF) and atrial fibrillation (AF) frequently coexist, exacerbate each other and are associated with increased morbidity and mortality rates. However, no previous study has specifically calculated the risk of experiencing either event following the occurrence of the other and also considered competing risks. The aim of this study was to examine the bidirectional relationship of AF and HF in a multiethnic population, taking competing risks into account.
Two Fine and Gray regression models of the subdistribution functions were implemented to evaluate the bidirectional association between AF and HF and were adjusted for a common set of covariates. Competing events were defined as HF/AF and/or cardiac death vs noncardiac death. For each model, common covariates for AF and HF were pre-identified in the literature, and either HF or AF was used as a time-dependent covariate.
In the Multi-Ethnic Study of Atherosclerosis (MESA), 4016 study participants (mean age 67.2 ± 7.6 years and 48.8% male participants), free of clinically recognized cardiovascular disease at baseline, were assessed for AF and HF. After a median (IQR) follow-up of 6034 (3994-6313) days, 1044 incident AFs, 302 incident HFs and 1298 events of death occurred. Deaths were distributed as 313 cardiac deaths and 985 noncardiac deaths, and the incidence of AF was about 3.5 higher than that of HF. We found that HF was associated with a composite outcome of AF and/or cardiac death (HR 2.91, 95%CI [2.49-3.40]; P < 0.001) and that AF was associated with a composite outcome of HF and/or cardiac death (HR 2.05, 95%CI [1.79-2.35]; P < 0.001).
AF and HF exacerbate the incidence of each other and are strongly and independently associated, suggesting that their joint association should be taken into consideration in future studies. From a clinical perspective, the occurrence of either of these events greatly increases the risk for the other (ClinicalTrials.gov Identifier: NCT00005487).
心力衰竭（HF）和心房颤动（AF）常并存，相互加重，且与发病率和死亡率增加相关。然而，既往尚无研究专门计算一方事件发生后另一方发生的风险，也未考虑竞争风险。本研究旨在探讨多民族人群中AF与HF的双向关系，并考虑竞争风险。
采用两个亚分布函数的Fine和Gray回归模型评估AF与HF之间的双向关联，并对一组共同的协变量进行调整。竞争事件定义为HF/AF和/或心源性死亡与非心源性死亡。对于每个模型，在文献中预先确定AF和HF的共同协变量，并将HF或AF用作时间依存协变量。
在动脉粥样硬化多民族研究（MESA）中，对4016名研究参与者（平均年龄67.2±7.6岁，男性参与者占48.8%）进行了AF和HF评估，这些参与者在基线时无临床公认的心血管疾病。经过中位（IQR）随访6034（3994 - 6313）天，发生了1044例新发AF、302例新发HF和1298例死亡事件。死亡分布为313例心源性死亡和985例非心源性死亡，AF的发病率比HF高约3.5倍。我们发现HF与AF和/或心源性死亡的复合结局相关（HR 2.91，95%CI [2.49 - 3.40]；P < 0.001），且AF与HF和/或心源性死亡的复合结局相关（HR 2.05，95%CI [1.79 - 2.35]；P < 0.001）。
AF和HF相互加重发病率，且存在强烈且独立的关联，提示在未来研究中应考虑它们的联合关联。从临床角度看，这两种事件中的任何一种发生都会大大增加另一种事件发生的风险（ClinicalTrials.gov标识符：NCT00005487）。
