Atrial Fibrillation in Heart Failure With Preserved, Mid-Range, and Reduced Ejection Fraction
Atrial Fibrillation in Heart Failure With Preserved, Mid-Range, and Reduced Ejection Fraction
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DOI：
10.1016/j.jchf.2017.05.001
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发表时间：
2017-08-01
影响因子：
13
通讯作者：
Lund, Lars H.
中科院分区：
文献类型：
--
作者：
Sartipy, Ulrik;Dahlstrom, Ulf;Lund, Lars H.
目的 本研究旨在评估射血分数保留的心力衰竭 (HF) (HFpEF)、射血分数中等的心力衰竭 (HFmrEF) 和射血分数降低的心力衰竭 (HFrEF) 中房颤 (AF) 与窦性心律 (SR) 的独立危险因素、后果和结果。 背景 AF 在 HF 中很常见，但大多数数据来自 HFrEF。 AF 在 HFpEF 和 HFmrEF 中的重要性鲜为人知。方法在瑞典 HF（瑞典心力衰竭登记处）登记处的 2000 年至 2012 年患者中，通过国家卫生保健登记处的患者级数据丰富，作者评估了 HFpEF 与 HFmrEF 与 HFrEF 中 AF 的患病率、关联性和预后影响。 结果 41,446患者中，23% 患有 HFpEF，22% 患有 HFmrEF，55% 患有 HFrEF。 HFpEF、HFmrEF 和 HFrEF 中 AF 的患病率分别为 65%、60% 和 53%。 HFpEF、HFmrEF 和 HFrEF 与 AF 的独立关联相似，包括年龄较大、男性、心力衰竭持续时间、既往心肌梗死以及既往中风或短暂性脑缺血发作 (TIA)。 HFpEF、HFmrEF 和 HFrEF 中 AF 与 SR 的调整后风险比如下：死亡为 1.11（95% 置信区间 [CI]：1.02 至 1.21）、1.22（95% CI：1.12 至 1.33）和 1.17（95% CI：1.11 至 1.23）；心力衰竭住院或死亡为 1.17（95% CI：1.09 至 1.26）、1.29（95% CI：1.20 至 1.40）和 1.15（95% CI：1.10 至 1.20）；对于中风或 TIA 或死亡，分别为 1.15（95% CI：1.07 至 1.25）、1.23（95% CI：1.13 至 1.34）和 1.19（95% CI：1.14 至 1.26）。 HFmrEF 和 HFrEF。在所有射血分数组中，房颤均与死亡、心力衰竭住院、中风或 TIA 风险增加相关。相比之下，AF 和 SR 人群在相关患者特征和结果方面存在显着差异。 (C) 2017 年，美国心脏病学会基金会。
OBJECTIVES The study sought to assess the independent risk factors for, consequences of, and outcomes with atrial fibrillation (AF) compared with sinus rhythm (SR) in heart failure (HF) with preserved ejection fraction (HFpEF) versus HF with mid-range ejection fraction (HFmrEF) versus HF with reduced ejection fraction (HFrEF).BACKGROUND AF is common in HF, but most data are from HFrEF. The importance of AF in HFpEF and HFmrEF is less well known.METHODS In patients from 2000 to 2012 in the SwedeHF (Swedish Heart Failure Registry) registry, enriched with patient-level data from national health care registries, the authors assessed prevalence of, associations with, and prognostic impact of AF in HFpEF versus HFmrEF versus HFrEF.RESULTS Of 41,446 patients, 23% had HFpEF, 22% had HFmrEF, and 55% had HFrEF. The prevalence of AF was 65%, 60%, and 53% in HFpEF, HFmrEF, and HFrEF, respectively. Independent associations with AF were similar in HFpEF, HFmrEF, and HFrEF and included greater age, male, duration of HF, prior myocardial infarction, and prior stroke or transient ischemic attack (TIA). The adjusted hazard ratios for AF versus SR in HFpEF, HFmrEF, and HFrEF were the following: for death, 1.11 (95% confidence interval [CI]: 1.02 to 1.21), 1.22 (95% CI: 1.12 to 1.33), and 1.17 (95% CI: 1.11 to 1.23); for HF hospitalization or death, 1.17 (95% CI: 1.09 to 1.26), 1.29 (95% CI: 1.20 to 1.40), and 1.15 (95% CI: 1.10 to 1.20); and for stroke or TIA or death, 1.15 (95% CI: 1.07 to 1.25), 1.23 (95% CI: 1.13 to 1.34), and 1.19 (95% CI: 1.14 to 1.26).CONCLUSIONS AF was progressively more common with increasing ejection fraction, but was associated with similar clinical characteristics in HFpEF, HFmrEF, and HFrEF. AF was associated with similarly increased risk of death, HF hospitalization, and stroke or TIA in all ejection fraction groups. In contrast, AF and SR populations were considerably different regarding associated patient characteristics and outcomes. (C) 2017 by the American College of Cardiology Foundation.