Intersection of atrial fibrillation and heart failure with mildly reduced and preserved ejection fraction in >400 000 participants in the Get With The Guidelines-Heart Failure Registry

Ravi B. Patel; Stephen J. Greene; Haolin Xu; Brooke Alhanti; Pamela Peterson; Clyde W. Yancy; Jonathan Piccini; Gregg C. Fonarow; Muthiah Vaduganathan

doi:10.1002/ejhf.2729

Intersection of atrial fibrillation and heart failure with mildly reduced and preserved ejection fraction in >400 000 participants in the Get With The Guidelines-Heart Failure Registry

Ravi B. Patel, Stephen J. Greene, Haolin Xu, Brooke Alhanti, Pamela Peterson, Clyde W. Yancy, Jonathan Piccini, Gregg C. Fonarow, Muthiah Vaduganathan^*

^*Corresponding author for this work

Medicine, Cardiology Division

Research output: Contribution to journal › Article › peer-review

4 Scopus citations

Abstract

Aims: Although atrial fibrillation (AF) frequently coexists with heart failure with preserved ejection fraction (HFpEF), few data are available evaluating AF-specific care patterns and post-discharge outcomes in patients hospitalized for HFpEF. We evaluated AF-specific medical therapies and post-discharge outcomes among patients hospitalized for heart failure with mildly reduced ejection fraction (HFmrEF) or HFpEF by AF history. Methods and results: Trends in AF prevalence were evaluated among patients hospitalized for HFmrEF or HFpEF in the Get With The Guidelines-Heart Failure Registry from 2014 to 2020. Among those with linked Centers for Medicare & Medicaid Services post-discharge data, we assessed associations of AF with 12-month outcomes and determined trends in post-discharge prescriptions. Among 429 464 patients (median age 76 years [interquartile range 65–85], 57% women), 216 486 (50%) had a history of AF. Over time, the proportion of patients with AF increased slightly. Among the 79 895 patients with post-discharge data, AF was independently associated with higher risk of mortality and all-cause readmissions at 12 months, with stronger associations in HFpEF than in HFmrEF (mortality hazard ratio [HR] 1.13, 95% confidence interval [CI] 1.09–1.16 vs. HR 1.03, 95% CI 0.97–1.10; p_interaction = 0.009). Anti-arrhythmic drug use after heart failure hospitalization was low (18%) and increased modestly over time. Amiodarone accounted for 71% of total anti-arrhythmic drug prescriptions. Overall use of anticoagulants after heart failure hospitalization has significantly increased from 52% in 2014 to 61% in 2019, but remained modest. Conclusion: Prevalence of AF is rising among patients hospitalized with HFpEF. Those with comorbid AF face elevated post-discharge risks of death and rehospitalization. Current use of pharmacological rhythm control is low.

Original language	English (US)
Pages (from-to)	63-73
Number of pages	11
Journal	European Journal of Heart Failure
Volume	25
Issue number	1
DOIs	https://doi.org/10.1002/ejhf.2729
State	Published - Jan 2023

Keywords

Anti-arrhythmic drug
Atrial fibrillation
Clinical outcomes
Heart failure with preserved ejection fraction
Hospitalization
Registry

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine

Access to Document

10.1002/ejhf.2729

Cite this

Patel, R. B., Greene, S. J., Xu, H., Alhanti, B., Peterson, P., Yancy, C. W., Piccini, J., Fonarow, G. C., & Vaduganathan, M. (2023). Intersection of atrial fibrillation and heart failure with mildly reduced and preserved ejection fraction in >400 000 participants in the Get With The Guidelines-Heart Failure Registry. European Journal of Heart Failure, 25(1), 63-73. https://doi.org/10.1002/ejhf.2729

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title = "Intersection of atrial fibrillation and heart failure with mildly reduced and preserved ejection fraction in >400 000 participants in the Get With The Guidelines-Heart Failure Registry",

abstract = "Aims: Although atrial fibrillation (AF) frequently coexists with heart failure with preserved ejection fraction (HFpEF), few data are available evaluating AF-specific care patterns and post-discharge outcomes in patients hospitalized for HFpEF. We evaluated AF-specific medical therapies and post-discharge outcomes among patients hospitalized for heart failure with mildly reduced ejection fraction (HFmrEF) or HFpEF by AF history. Methods and results: Trends in AF prevalence were evaluated among patients hospitalized for HFmrEF or HFpEF in the Get With The Guidelines-Heart Failure Registry from 2014 to 2020. Among those with linked Centers for Medicare & Medicaid Services post-discharge data, we assessed associations of AF with 12-month outcomes and determined trends in post-discharge prescriptions. Among 429 464 patients (median age 76 years [interquartile range 65–85], 57% women), 216 486 (50%) had a history of AF. Over time, the proportion of patients with AF increased slightly. Among the 79 895 patients with post-discharge data, AF was independently associated with higher risk of mortality and all-cause readmissions at 12 months, with stronger associations in HFpEF than in HFmrEF (mortality hazard ratio [HR] 1.13, 95% confidence interval [CI] 1.09–1.16 vs. HR 1.03, 95% CI 0.97–1.10; pinteraction = 0.009). Anti-arrhythmic drug use after heart failure hospitalization was low (18%) and increased modestly over time. Amiodarone accounted for 71% of total anti-arrhythmic drug prescriptions. Overall use of anticoagulants after heart failure hospitalization has significantly increased from 52% in 2014 to 61% in 2019, but remained modest. Conclusion: Prevalence of AF is rising among patients hospitalized with HFpEF. Those with comorbid AF face elevated post-discharge risks of death and rehospitalization. Current use of pharmacological rhythm control is low.",

keywords = "Anti-arrhythmic drug, Atrial fibrillation, Clinical outcomes, Heart failure with preserved ejection fraction, Hospitalization, Registry",

author = "Patel, {Ravi B.} and Greene, {Stephen J.} and Haolin Xu and Brooke Alhanti and Pamela Peterson and Yancy, {Clyde W.} and Jonathan Piccini and Fonarow, {Gregg C.} and Muthiah Vaduganathan",

note = "Publisher Copyright: {\textcopyright} 2022 European Society of Cardiology.",

year = "2023",

month = jan,

doi = "10.1002/ejhf.2729",

language = "English (US)",

volume = "25",

pages = "63--73",

journal = "European Journal of Heart Failure",

issn = "1388-9842",

publisher = "Oxford University Press",

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Patel, RB, Greene, SJ, Xu, H, Alhanti, B, Peterson, P, Yancy, CW, Piccini, J, Fonarow, GC & Vaduganathan, M 2023, 'Intersection of atrial fibrillation and heart failure with mildly reduced and preserved ejection fraction in >400 000 participants in the Get With The Guidelines-Heart Failure Registry', European Journal of Heart Failure, vol. 25, no. 1, pp. 63-73. https://doi.org/10.1002/ejhf.2729

Intersection of atrial fibrillation and heart failure with mildly reduced and preserved ejection fraction in >400 000 participants in the Get With The Guidelines-Heart Failure Registry. / Patel, Ravi B.; Greene, Stephen J.; Xu, Haolin et al.
In: European Journal of Heart Failure, Vol. 25, No. 1, 01.2023, p. 63-73.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Intersection of atrial fibrillation and heart failure with mildly reduced and preserved ejection fraction in >400 000 participants in the Get With The Guidelines-Heart Failure Registry

AU - Patel, Ravi B.

AU - Greene, Stephen J.

AU - Xu, Haolin

AU - Alhanti, Brooke

AU - Peterson, Pamela

AU - Yancy, Clyde W.

AU - Piccini, Jonathan

AU - Fonarow, Gregg C.

AU - Vaduganathan, Muthiah

PY - 2023/1

Y1 - 2023/1

N2 - Aims: Although atrial fibrillation (AF) frequently coexists with heart failure with preserved ejection fraction (HFpEF), few data are available evaluating AF-specific care patterns and post-discharge outcomes in patients hospitalized for HFpEF. We evaluated AF-specific medical therapies and post-discharge outcomes among patients hospitalized for heart failure with mildly reduced ejection fraction (HFmrEF) or HFpEF by AF history. Methods and results: Trends in AF prevalence were evaluated among patients hospitalized for HFmrEF or HFpEF in the Get With The Guidelines-Heart Failure Registry from 2014 to 2020. Among those with linked Centers for Medicare & Medicaid Services post-discharge data, we assessed associations of AF with 12-month outcomes and determined trends in post-discharge prescriptions. Among 429 464 patients (median age 76 years [interquartile range 65–85], 57% women), 216 486 (50%) had a history of AF. Over time, the proportion of patients with AF increased slightly. Among the 79 895 patients with post-discharge data, AF was independently associated with higher risk of mortality and all-cause readmissions at 12 months, with stronger associations in HFpEF than in HFmrEF (mortality hazard ratio [HR] 1.13, 95% confidence interval [CI] 1.09–1.16 vs. HR 1.03, 95% CI 0.97–1.10; pinteraction = 0.009). Anti-arrhythmic drug use after heart failure hospitalization was low (18%) and increased modestly over time. Amiodarone accounted for 71% of total anti-arrhythmic drug prescriptions. Overall use of anticoagulants after heart failure hospitalization has significantly increased from 52% in 2014 to 61% in 2019, but remained modest. Conclusion: Prevalence of AF is rising among patients hospitalized with HFpEF. Those with comorbid AF face elevated post-discharge risks of death and rehospitalization. Current use of pharmacological rhythm control is low.

AB - Aims: Although atrial fibrillation (AF) frequently coexists with heart failure with preserved ejection fraction (HFpEF), few data are available evaluating AF-specific care patterns and post-discharge outcomes in patients hospitalized for HFpEF. We evaluated AF-specific medical therapies and post-discharge outcomes among patients hospitalized for heart failure with mildly reduced ejection fraction (HFmrEF) or HFpEF by AF history. Methods and results: Trends in AF prevalence were evaluated among patients hospitalized for HFmrEF or HFpEF in the Get With The Guidelines-Heart Failure Registry from 2014 to 2020. Among those with linked Centers for Medicare & Medicaid Services post-discharge data, we assessed associations of AF with 12-month outcomes and determined trends in post-discharge prescriptions. Among 429 464 patients (median age 76 years [interquartile range 65–85], 57% women), 216 486 (50%) had a history of AF. Over time, the proportion of patients with AF increased slightly. Among the 79 895 patients with post-discharge data, AF was independently associated with higher risk of mortality and all-cause readmissions at 12 months, with stronger associations in HFpEF than in HFmrEF (mortality hazard ratio [HR] 1.13, 95% confidence interval [CI] 1.09–1.16 vs. HR 1.03, 95% CI 0.97–1.10; pinteraction = 0.009). Anti-arrhythmic drug use after heart failure hospitalization was low (18%) and increased modestly over time. Amiodarone accounted for 71% of total anti-arrhythmic drug prescriptions. Overall use of anticoagulants after heart failure hospitalization has significantly increased from 52% in 2014 to 61% in 2019, but remained modest. Conclusion: Prevalence of AF is rising among patients hospitalized with HFpEF. Those with comorbid AF face elevated post-discharge risks of death and rehospitalization. Current use of pharmacological rhythm control is low.

KW - Anti-arrhythmic drug

KW - Atrial fibrillation

KW - Clinical outcomes

KW - Heart failure with preserved ejection fraction

KW - Hospitalization

KW - Registry

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DO - 10.1002/ejhf.2729

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SN - 1388-9842

VL - 25

SP - 63

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JO - European Journal of Heart Failure

JF - European Journal of Heart Failure

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Intersection of atrial fibrillation and heart failure with mildly reduced and preserved ejection fraction in >400 000 participants in the Get With The Guidelines-Heart Failure Registry

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