The Prognostic Interplay of Heart Failure and Chronic Kidney Disease in Atrial Fibrillation - Focus on Cardiorenal Outcomes.

Background: HF and CKD create a mutually reinforcing cycle, escalating disease development, and increasing morbidity and mortality rates. Both are common comorbidities promoting AF and contributing to heightened symptom burden and poorer outcomes in AF. Here our aim was to investigate the relationship of heart failure (HF) and chronic kidney disease (CKD) with cardiorenal outcomes in patients with atrial fibrillation (AF).

Methods: Patients with AF, treated at a tertiary centre between 01/2005 and 07/2019 were included. The primary endpoint was a composite of cardiovascular (CV) death and hospitalization for HF (HHF). Secondary outcomes were the individual components of the primary endpoint, all-cause death, renal death, and dialysis.

Results: We included in total 7412 patients (median age 70 years, 39.7% female) with AF and followed them over a median of 4.5 years. There was a significant stepwise increase in 5-year's event rates for the composite of CV death/ HHF (no CKD & no HF: 23%, HF: 61%, CKD: 63%, CKD & HF: 82%; P-logrank <0.001). Both CKD (adjusted HR 1.87, 95% CI 1.55-2.25) and HF (adjusted HR 2.57, 95% CI 2.22-2.98) were significantly associated with CV death/ HHF after multivariable adjustment. A similar association was observed for the individual components of the primary endpoint and renal death/ dialysis.

Conclusions: Both CKD and HF significantly increase the risk of CV death and HHF, as well as renal death/ dialysis in patients with AF. Risk assessment should expand beyond stroke and bleeding to cardiorenal complications including HHF, CV and renal death, as well as kidney failure.