Permanent atrial fibrillation linked to heart failure incidence
Patients with permanent atrial fibrillation (AF) are at greater risk of developing heart failure, a study has found. Predictors of AF progression include AF duration, diabetes mellitus, heart failure, hyperthyroidism, sinus rhythm, cardioversion and valvular heart disease.
Researchers analysed AF patterns (paroxysmal, persistent and permanent), rate and predictors of AF progression, and outcomes in 3,223 patients (mean age 72 years; 40 percent female) from the PREFER* registry. Sensitivity analyses were performed using another PREFER dataset (n=6,390 patients).
AF progressed to more persistent types in 506 patients (17 percent). Compared with those who had paroxysmal AF, patients with permanent AF were more likely to develop heart failure at 1 year (odds ratio [OR], 1.80; 95 percent CI, 1.06–3.07; p=0.03).
In multivariable-adjusted models, the following factors predicted AF progression with area under the receiver operating characteristic curve of 0.60 (0.57–0.63): sinus rhythm at baseline, AF duration, cardioversion, hyperthyroidism, valvular heart disease, diabetes mellitus and heart failure.
Results were similar when analyses were restricted to patients with AF duration <1 year. Specifically, AF progression was associated with coronary events over 1 year (OR, 2.27; 1.22–4.19; p=0.0074).
Noting that AF is a rhythm disorder that progresses during a comparatively short 1-year time frame, researchers stressed that modifiable clinical predictors of AF progression exist and may represent targets for intervention to reduce progression rate.
Additional studies are needed to determine whether the progression rate can be reduced by targeting modifiable predictors, whether AF progression is associated with adverse events, and whether prevention of progression improves AF outcomes and should be integrated into AF management.
*PREvention oF thromboembolic events-European Registry