Atrial fibrillation and heart failure due to reduced versus preserved ejection fraction: A systematic review and meta-analysis of death and adverse outcomes
Open accessAbstract
Background Atrial fibrillation (AF) and heart failure frequently coexist, commonly resulting in serious adverse events. With both conditions increasing in prevalence and justified concerns about treatment efficacy, it is vital to understand how the type of heart failure impacts on prognosis.Methods We performed a systematic review of studies examining cardiovascular outcomes in AF patients with heart failure and reduced ejection fraction (AF-HFrEF) compared to those with preserved ejection fraction (AF-HFpEF). The primary outcome was all-cause mortality, meta-analyzed using a random-effects model. Prospective registration: PROSPERO-CRD42014007305.Results Thirteen studies were included in the systematic review (n=54,587) with 10 suitable for meta-analysis, including retrospective/prospective cohorts and sub-group analyses of randomized trials. AF-HFrEF was present in 49% and these patients were younger, more often male and with higher NYHA class than AF-HFpEF. Oral anticoagulation use was 55% versus 50% respectively (p<0.001). All-cause mortality was significantly higher in AF-HFrEF; risk ratio (RR) 1.24, 95% CI 1.12-1.36, p<0.001 (n=45,100), with absolute death rates of 24% compared to 18% in AF-HFpEF over 2 years. There were no significant differences in incident stroke (RR 0.85, 95% CI 0.70-1.03, p=0.094; n=33,773) or heart failure hospitalization (RR 1.21, 95% CI 0.96-1.53, p=0.115; n=31,583). The risk of bias was generally low, but heterogeneity was substantial.Conclusions All-cause mortality is significantly higher in AF patients with HFrEF compared to HFpEF, although stroke risk and heart failure hospitalization are similar. Further studies are needed to address the prevention of adverse outcomes in all AF patients with heart failure, regardless of ejection fraction.
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- Authors
- Kotecha, D., Chudasama, R., Lane, D. A., Kirchhof, P., & Lip, G. Y. H.
- Affiliations
- University of Birmingham (GB)
- Corresponding author
- Kotecha, Dipak
- Venue
- International Journal of Cardiology
- Publisher
- Elsevier BV
- Published
- 2016-01
- Volume
- 203
- Pages
- 660-666
- ISSN
- 0167-5273 (ISSN-L)
- OpenAlex
- W1880722242
- Cited by
- 199
- References
- 54
- Citations by year
- 2026: 5 · 2025: 14 · 2024: 16 · 2023: 18 · 2022: 22 · 2021: 28 · 2020: 26 · 2019: 15 · 2018: 21 · 2017: 18 · 2016: 15
- FWCI
- 3.11
- Type
- journal article
- Language
- en
- Open access
- Licence
- cc-by-nc-nd
- www.elsevier.com/tdm/userlicense/1.0/ (tdm)
- Locations
- International Journal of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- University of Birmingham Research Portal (University of Birmingham) (submittedVersion, cc-by-nc-nd)
- Funders
- University of Birmingham
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
- Keywords
- atrial fibrillation, heart failure, reduced ejection fraction, preserved ejection fraction, all-cause mortality, stroke, heart failure hospitalization, prognosis, oral anticoagulation
- MeSH terms
- Atrial Fibrillation, Heart Failure, Humans, Prognosis, Stroke Volume
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