The Prevalence and Prognostic Significance of Atrial Fibrillation in Patients with Heart Failure and Preserved Ejection Fraction

Introduction: Heart failure (HF) with preserved ejection fraction (HFPEF) accounts for around half of the HF cases in Australia, yet management strategies are limited. Typically, patients with HFPEF are complex with a high burden of comorbid disease which impacts adversely on prognosis. Methods: We evaluated the prevalence and prognostic significance of atrial fibrillation (AF) in a large cohort of patients with HFPEF managed within the GenesisCare Heart Failure Management Clinics (GC-HFMCs) throughout Australia. Patients maintained on evidence-based medications were stratified into those with a history of AF or not. Baseline characteristics, all-cause mortality at 1 year and intermediate term follow-up were compared between groups. Results: 297 consecutive patients were included in the analysis, mean age 79 ± 10 years, female 62%, history of hypertension (83%), diabetes (34%) and myocardial infarction (13%). Left atrial enlargement was common (LA area 26 cm2, IQR 22–31 cm2). 180 patients (61%) had a history of AF, although only 21% had AF on ECG at initial review. Patients were followed prospectively for a median of 1.8 years (IQR 1.0–2.5 years) during which there were 38 deaths (13%). Logistic regression analysis demonstrated that history of AF was significantly associated with all-cause mortality at one year (Table 1).Table 1All cause mortalityOR AF vs no AF95% CIp1 year3.71.1 – 13.00.04Median follow-up (1.8 yrs.)2.71.2 – 6.20.02 Open table in a new tab Conclusions: AF is common, frequently paroxysmal and, associated with worse prognosis in HFPEF. Whilst the role of AF ablation in HFPEF remains uncertain, proactive strategies to identify, risk stratify and treat AF in HFPEF are critical to optimise outcomes of patients with HFPEF.