Prognostic significance of atrial fibrillation in acute decompensated heart failure with reduced versus preserved ejection fraction

Alexander Jobs*, Julia Schwind, Alexander Katalinic, Valentin Babaev, Roland Richard Tilz, Stefan Rausch, Holger Thiele, Ingo Eitel, Charlotte Eitel

*Corresponding author for this work
5 Citations (Scopus)


OBJECTIVE: The prognostic impact of atrial fibrillation (AF) in patients with acute decompensated heart failure (ADHF) has not been fully elucidated yet. Aim of the present study was thus to investigate the association of AF with all-cause mortality in patients with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF).

METHODS: We performed a retrospective single center study and analyzed data of 1286 patients admitted for ADHF. Patients were grouped according to AF status (i.e., "never AF", "history of AF", or "AF on admission") and type of heart failure. Patient and treatment characteristics were extracted by chart review. The primary outcome of all-cause mortality within 3 years following index hospitalization was determined by death registry linkage.

RESULTS: In total, 529 (41.1%), 215 (16.7%), and 542 (42.1%) patients were grouped as "never AF", "history of AF", and "AF on admission", respectively. With regard to type of heart failure, 558 (43.4%) and 728 (56.6%) had HFrEF and HFpEF, respectively. Compared to "never AF", "AF on admission" was associated with increased all-cause mortality in an adjusted Cox regression model [hazard ratio, 1.64 (95% confidence interval 1.32-2.04); P < 0.001]. However, this association remained significant only for patients with HFpEF [2.16 (1.58-2.95)], but not for patients with HFrEF [1.18 (0.85-1.63)] in a subgroup analysis (P for effect modification = 0.020).

CONCLUSIONS: AF is common in the setting of ADHF and is associated with increased all-cause mortality. However, this association remained significant only in patients with HFpEF, but not in patients with HFrEF.

Original languageEnglish
JournalClinical Research in Cardiology
Issue number1
Pages (from-to)74-82
Number of pages9
Publication statusPublished - 18.01.2019

Research Areas and Centers

  • Research Area: Center for Population Medicine and Public Health (ZBV)
  • Centers: Cardiological Center Luebeck (UHZL)

DFG Research Classification Scheme

  • 205-02 Public Health, Health Services Research and Social Medicine
  • 205-12 Cardiology, Angiology


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