Atrial fibrillation in patients with heart failure with reduced, mildly reduced, and preserved ejection fraction: a report from the HEart failuRe ObsErvational Study (HEROES).

Abstract

Background: Heart failure (HF) and atrial fibrillation (AF) often coexist and modify each other's course. The prevalence and clinical characteristic of AF differ in specific HF subtypes.

Aims: The study aimed to evaluate the incidence and clinical features of people with AF in comparison to those with sinus rhythm in HF, across the three HF subtypes categorized by left ventricular ejection fraction (EF).

Methods: Hospitalized patients and outpatients were enrolled in the Heart failuReObsErvationalStudy, a prospective, multicenter cohort study. HF subtypes were defined as reduced EF (HFrEF, EF<40%), mildly reduced EF (HFmrEF, EF 40%-49%) or preserved EF(HFpEF, EF≥50%).

Results: A total of 1,210 patients with HF were included in the study (71.8% male). Among them, 51.8% had HFrEF, 21.7% had HFmrEF, and 26.5% had HFpEF. Within the entire HF study population, 79.5% were hospitalized, and AF was present in 51.8% of patients. The prevalence of AF was 53.9% in HFrEF, 49.7% in HFmrEF, and 51.7% in HFpEF (P=0.59). The strongest factors independently associated with AF in different HF subtypes were echocardiographic abnormalities: aortic regurgitation in patients with HFpEF (OR 9.02, CI 1.14-71.27, P<0.001), left atrial volume > median in patients with HFmrEF (OR 6.21, CI 2.24-17.2, P<0.001) and in patients with HFrEF (OR 3.9, CI 2.21-6.90, P<0.001). Selected independent associations with AF were similar in HFpEF, HFmrEF, and HFrEF groups.

Conclusions: In the population with HF, the AF incidence is similar in the HFrEF, HFmrEF and HFpEF groups. It is associated with similar clinical characteristics in HF subtypes.