Determinants of mortality in patients with heart failure and atrial fibrillation during long-term follow-up.

摘要

BACKGROUND: Heart failure (HF) and atrial fibrillation (AF) often occur together. Both are independently associated with an increased mortality. Clinical parameters associated with mortality in patients with HF such as left ventricular ejection fraction (LV-EF) and New York Heart Association (NYHA) functional class are influenced by AF. If these parameters are still determinants of mortality when HF is complicated by AF, or if other parameters determine mortality in this case is unknown. METHODS AND RESULTS: We studied 173 consecutive HF patients (mean age 67 +/- 12 years, 30% female) in New York Heart Association (NYHA) functional class 2.6 +/- 0.8 with left ventricular systolic dysfunction (ejection fraction 45%) and AF. Mortality was 42% after a mean follow-up of 41 months. Age (OR 1.04, CI 1.01-1.07, P = 0.003), chronic obstructive pulmonary disease (OR 2.07, Cl 1.15-3.73, P = 0.015), elevated serum creatinine at admission (OR 1.25, Cl 1.01-1.54, P = 0.033), prolongation of QRS duration (OR 1.02, CI 1.01-1.54, P= 0.001), decreased serum sodium at admission (OR 0.94, Cl 0.89-0.99, P = 0.026) and oral anticoagulation (OR 0.59, Cl 0.36-0.99, P = 0.046) were independently associated with mortality when assessed with multivariable Cox proportional hazard analysis. Importantly, mortality was not associated with NYHA functional class or left ventricular ejection fraction (LVEF). CONCLUSIONS: Elevated creatinine levels, decreased serum sodium levels, prolongation of QRS duration and the presence of COPD are associated with long-term mortality after hospitalization in patients with HF and AF. Oral anticoagulation is associated with better survival. LVEF and NYHA functional class are no reliable mortality markers in this patient population.