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Effect of Atrial Fibrillation on Mortality, Stroke Risk, and Quality-of-Life Scores in Patients With Heart Failure (from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation [ORBIT-AF]).

Publication ,  Journal Article
Cherian, TS; Shrader, P; Fonarow, GC; Allen, LA; Piccini, JP; Peterson, ED; Thomas, L; Kowey, PR; Gersh, BJ; Mahaffey, KW
Published in: Am J Cardiol
June 1, 2017

The degree to which clinical outcomes are worsened in patients with atrial fibrillation (AF) with heart failure (HF) compared with those without HF is not well described. This study aimed to determine the impact of HF on clinical outcomes in patients with AF. We analyzed data from Outcomes Registry for Better Informed Treatment of Atrial Fibrillation, a national registry of 10,135 patients with AF to determine associations between HF and left ventricular ejection fraction (LVEF) and outcomes, including stroke, mortality, and hospitalization using Cox multivariable modeling. Atrial Fibrillation Effect on Quality-of-Life Questionnaire (AFEQT) scores between groups were also compared. Overall, 33% (n = 3,203) of patients had HF; of these 33% (n = 985) had LVEF ≤40%. Oral anticoagulation was prescribed more commonly in patients with HF (81% vs 74%). Compared with patients without HF, those with HF had similar rate of stroke (1.28 vs 0.88 per 100-patient years, hazard ratio [HR] 1.11, confidence interval [CI] 0.83 to 1.48, p = 0.47) but higher mortality (HR 1.69, CI 1.49 to 1.92, p <0.001) and hospitalization (HR 1.31, CI 1.23 to 1.39, p <0.0001). Patients with LVEF ≤40% had similar stroke risk (HR 1.06, CI 0.67 to 1.67) but higher mortality (HR 2.06, CI 1.74 to 2.44) and hospitalization (HR 1.38, CI 1.25 to 1.51). AFEQT overall score was significantly lower (76.9 vs 83.3, p <0.0001) in patients with HF. In conclusion, HF was associated with increased risk of death and hospitalization and worse quality of life, but similar rates of thromboembolism regardless of LVEF among patients with AF. These findings highlight the need to develop therapeutic strategies targeting functional status and survival for patients with HF and AF.

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Published In

Am J Cardiol

DOI

EISSN

1879-1913

Publication Date

June 1, 2017

Volume

119

Issue

11

Start / End Page

1763 / 1769

Location

United States

Related Subject Headings

  • Ventricular Function, Left
  • United States
  • Thrombolytic Therapy
  • Survival Rate
  • Surveys and Questionnaires
  • Stroke Volume
  • Stroke
  • Risk Factors
  • Registries
  • Quality of Life
 

Citation

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Cherian, T. S., Shrader, P., Fonarow, G. C., Allen, L. A., Piccini, J. P., Peterson, E. D., … Mahaffey, K. W. (2017). Effect of Atrial Fibrillation on Mortality, Stroke Risk, and Quality-of-Life Scores in Patients With Heart Failure (from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation [ORBIT-AF]). Am J Cardiol, 119(11), 1763–1769. https://doi.org/10.1016/j.amjcard.2017.02.050
Cherian, Tharian S., Peter Shrader, Gregg C. Fonarow, Larry A. Allen, Jonathan P. Piccini, Eric D. Peterson, Laine Thomas, Peter R. Kowey, Bernard J. Gersh, and Kenneth W. Mahaffey. “Effect of Atrial Fibrillation on Mortality, Stroke Risk, and Quality-of-Life Scores in Patients With Heart Failure (from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation [ORBIT-AF]).Am J Cardiol 119, no. 11 (June 1, 2017): 1763–69. https://doi.org/10.1016/j.amjcard.2017.02.050.
Cherian TS, Shrader P, Fonarow GC, Allen LA, Piccini JP, Peterson ED, Thomas L, Kowey PR, Gersh BJ, Mahaffey KW. Effect of Atrial Fibrillation on Mortality, Stroke Risk, and Quality-of-Life Scores in Patients With Heart Failure (from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation [ORBIT-AF]). Am J Cardiol. 2017 Jun 1;119(11):1763–1769.
Journal cover image

Published In

Am J Cardiol

DOI

EISSN

1879-1913

Publication Date

June 1, 2017

Volume

119

Issue

11

Start / End Page

1763 / 1769

Location

United States

Related Subject Headings

  • Ventricular Function, Left
  • United States
  • Thrombolytic Therapy
  • Survival Rate
  • Surveys and Questionnaires
  • Stroke Volume
  • Stroke
  • Risk Factors
  • Registries
  • Quality of Life