Predictors and risk model for heart failure hospitalization in atrial fibrillation patients without pre-existing heart failure: the Fushimi AF Registry. (14th October 2021)

• Record Type: Journal Article
• Authors: Hamatani, Y; Iguchi, M; Minami, K; Ishigami, K; Ikeda, S; Doi, K; Masunaga, N; Esato, M; Tsuji, H; Wada, H; Hasegawa, K; Ogawa, H; Abe, M; Akao, M
• Is Part Of: European heart journal. Volume 42(2021)Supplement 1
• Publication Date: 2021-10-14
• Subjects: Heart Failure in Atrial Fibrillation; Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; 616.12005
• DOI: 10.1093/eurheartj/ehab724.0476
• Languages: English
• ISSNs: 0195-668X

Abstract

Abstract: Background: Atrial fibrillation (AF) increases the risk of hospitalization for heart failure (HF), as well as that of thromboembolism. The strategy for prediction of thromboembolism has been well-established; however, little focus has been placed on the risk stratification for and prevention of HF hospitalization in AF patients. Purpose: The aim of this study is to investigate the predictors and risk model of HF hospitalization in non-valvular AF patients without pre-existing HF. Methods: The Fushimi AF Registry is a community-based prospective survey of AF patients in Fushimi-ku, Kyoto, Japan. The inclusion criterion of the registry is the documentation of AF at 12-lead electrocardiogram or Holter monitoring at any time, and there are no exclusion criteria. We started to enroll patients from March 2011, and follow-up data were available for 4, 472 patients by the end of October 2020. From the registry, we excluded patients without a pre-existing HF (defined as having one of the following; prior hospitalization for HF, New York Heart Association class ≥2, or left ventricular ejection fraction [LVEF] <40%), and those with valvular AF (mitral stenosis or prosthetic heart valve). Among 3, 188 non-valvular AF patients without pre-existing HF, we explored the risk factors for the HF hospitalization during follow-up period. The risk model for predicting HF hospitalization was determined by the cumulative numbers of risk factors which were significant on multivariate analysis. Results: The mean age was 72.4±10.8 years, 1197 were female and 1787 were paroxysmal AF. The mean CHADS2 and CHA2DS2-VASc scores were 1.7±1.2 and 2.9±1.6, respectively. During the median follow-up period of 5.1 years, HF hospitalization occurred in 285 (8.9%), corresponding to an annual incidence of 1.8 events per 100 person-years. In multivariable Cox regression analysis, advanced age (≥75 years), valvular heart disease, coronary artery disease, reduced LVEF (<60%), chronic obstructive pulmonary disease (COPD) and anemia were independently associated with the higher incidence of HF hospitalization (all P<0.001) (Picture 1). A risk model based on these 6 variables could stratify the incidence of HF hospitalization during follow-up period (log-rank; P<0.001) (Picture 2). Patients with ≥3 risk factors had an 11-fold higher incidence of HF hospitalization compared with those not having any of these risk factors (hazard ratio: 11.3, 95% confidence interval: 7.0–18.4; P<0.001). Conclusions: Advanced age, coronary artery disease, valvular heart disease, reduced LVEF, COPD and anemia were independently associated with the risk of HF hospitalization in AF patients without pre-existing HF. There was good prediction for endpoint of HF hospitalization using these 6 variables, providing the opportunities for the implementation of strategies to reduce the incidence of HF among AF patients. Funding Acknowledgement: Type of funding sources: None.