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

17 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

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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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 = "John Wiley and Sons Ltd",

number = "1",

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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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ER -

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

Keywords

ASJC Scopus subject areas

UN SDGs

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