Cited by 574Atrial Fibrillation Management and OutcomesHeart Failure Treatment and ManagementCardiac Health and Mental Health

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Atrial Fibrillation and Risk of Clinical Events in Chronic Heart Failure With and Without Left Ventricular Systolic Dysfunction

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Olsson, Lars G., Swedberg, Karl, Ducharme, Anique, Granger, Christopher B., Michelson, Eric L., McMurray, John J.V., Puu, Margareta, Yusuf, Salim, Pfeffer, Marc A.·2006·Journal of the American College of Cardiology

DOI 10.1016/j.jacc.2006.01.060

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Abstract

Objectives We assessed the risk of adverse cardiovascular (CV) outcomes associated with atrial fibrillation (AF) in the Candesartan in Heart failure-Assessment of Reduction in Mortality and morbidity (CHARM) program, which enrolled patients with chronic heart failure (CHF) and a broad range of ejection fractions (EFs).Background Atrial fibrillation is associated with an increased risk of adverse CV outcomes in patients with CHF and reduced EF. The risk of AF in patients with CHF and preserved left ventricular ejection fraction (PEF) is unknown.Methods A total of 7,599 patients with symptomatic CHF were randomized to candesartan or placebo. Patients were divided by baseline EF (< or =40% or >40%) in low or preserved EF groups. Major outcomes were cardiovascular death or hospitalization for worsening heart failure, and all-cause mortality. Median follow-up was 37.7 months.Results A total of 670 (17%) patients in the low EF group and 478 (19%) in the PEF group had AF at baseline. Atrial fibrillation predicted a high risk of cardiovascular morbidity and mortality regardless of baseline EF. Patients with AF and low EF had the highest absolute risk for adverse CV outcomes. However, AF was associated with greater relative increased risk of the major outcomes in patients with PEF than in patients with low EF: hazard ratio 1.72 (95% confidence interval [CI] 1.45 to 2.06) versus 1.29 (95% CI 1.14 to 1.46), respectively. The same was true for the risk of all-cause mortality. Candesartan was associated with similar treatment effects regardless of baseline rhythm.Conclusions Atrial fibrillation is associated with an increased risk of CV outcomes in patients with CHF and either reduced EF or PEF. Candesartan improved outcomes similarly regardless of baseline rhythm.

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Epidemiology of Atrial Fibrillation and Heart Failure
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“Future studies of heart failure and AF should consider these aspects to improve our understanding of their complex inter-relationship.(17) Our findings suggest that regardless of other comorbidities such as heart failure, patients with permanent AF have a considerable risk of residual morbidity and mortality, even aft…”
Background
2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation
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Sex‐ and Race‐Related Differences in Characteristics and Outcomes of Hospitalizations for Heart Failure With Preserved Ejection Fraction
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The Central Role of Left Atrium in Heart Failure
Carpenito, M., Fanti, D., Mega, S., Benfari, G., Bono, M. C., Rossi, A., Ribichini, F. L., & Grigioni, F. (2021) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2021.704762 · Cited by 60
Atrial Fibrillation in Patients With Cardiomyopathy: Prevalence and Clinical Outcomes From Real‐World Data
Buckley, B. J. R., Harrison, S. L., Gupta, D., Fazio‐Eynullayeva, E., Underhill, P., & Lip, G. Y. H. (2021) · Journal of the American Heart Association · doi:10.1161/jaha.121.021970 · Cited by 64
Catheter ablation of atrial fibrillation reduces heart failure rehospitalization in patients with heart failure with preserved ejection fraction
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How does Chronic Atrial Fibrillation Influence Mortality in the Modern Treatment Era?
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“However, therapeutic CHF studies demonstrated conflicting results as to whether the presence of AF conferred an independent impact on mortality, or simply reflected disease state at baseline [37-40].”
Result
Heart Failure with Preserved Ejection Fraction: Current Understandings and Challenges
Andersen, M. J., & Borlaug, B. A. (2014) · Current Cardiology Reports · doi:10.1007/s11886-014-0501-8 · Cited by 59
The effect of statins on mortality in heart failure with preserved ejection fraction: a meta-analysis of propensity score analyses
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Is Heart Rate a Risk Marker in Patients with Chronic Heart Failure and Concomitant Atrial Fibrillation? Results from the MAGGIC Meta-Analysis
Simpson, J., Castagno, D., Doughty, R. N., Poppe, K., Earle, N. J., Squire, I. B., Richards, M., Andersson, B., Ezekowitz, J. A., Michel Komajda, N., et al. (2015) · European Journal of Heart Failure · doi:10.1002/ejhf.346 · Cited by 56
Left Atrial Electromechanical Conduction Time Can Predict Six-Month Maintenance of Sinus Rhythm After Electrical Cardioversion in Persistent Atrial Fibrillation by Doppler Tissue Echocardiography
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Atrial fibrillation is under-recognized in chronic heart failure: insights from a heart failure cohort treated with cardiac resynchronization therapy
Caldwell, J. C., Contractor, H., Petkar, S., Ali, R., Clarke, B., Garratt, C. J., Neyses, L., & Mamas, M. A. (2009) · EP Europace · doi:10.1093/europace/eup201 · Cited by 54
“In addition, data from the CHARM study also demonstrate that new-onset AF is an independent predictor of adverse outcome in CHF patients with impaired or preserved LV systolic function.(11)”
BackgroundMethod
Pathophysiological and therapeutic implications in patients with atrial fibrillation and heart failure
Hohendanner, F., Heinzel, F. R., Blaschke, F., Pieske, B. M., Haverkamp, W., Boldt, H., & Parwani, A. S. (2017) · Heart Failure Reviews · doi:10.1007/s10741-017-9657-9 · Cited by 54
“About two third of patients with HFpEF eventually develop atrial fibrillation [3, 66] and atrial remodeling itself is a hallmark feature of the disease [63].”
Background
Atrial Fibrillation and Heart Failure: Update 2015
Thihalolipavan, S., & Morin, D. P. (2015) · Progress in Cardiovascular Diseases · doi:10.1016/j.pcad.2015.07.004 · Cited by 54
Meta-analysis of the Usefulness of Catheter Ablation of Atrial Fibrillation in Patients With Heart Failure With Preserved Ejection Fraction
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Association of Heart Rate with Mortality in Sinus Rhythm and Atrial Fibrillation in Heart Failure with Preserved Ejection Fraction
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Heart failure and atrial fibrillation: new concepts in pathophysiology, management, and future directions
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Comparison of Mortality and Morbidity in Patients With Atrial Fibrillation and Heart Failure With Preserved Versus Decreased Left Ventricular Ejection Fraction
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Top ten risk factors for morbidity and mortality in patients with chronic systolic heart failure and elevated heart rate: The SHIFT Risk Model
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Outcomes and costs of left atrial appendage closure from randomized controlled trial and real-world experience relative to oral anticoagulation
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“It is a leading cause of stroke(2) and is associated with heart failure and premature death.(3) The rising prevalence(4) of AF has increased hospitalizations and healthcare costs.”
Background
Atrial Fibrillation in Heart Failure With Preserved Ejection Fraction
Čikeš, M., Planinc, I., Claggett, B. L., Cunningham, J. W., Miličić, D., Sweitzer, N. K., Senni, M., Gori, M., Linssen, G. C. M., Shah, S. J., et al. (2022) · JACC Heart Failure · doi:10.1016/j.jchf.2022.01.018 · Cited by 56
Impact of Atrial Fibrillation on Exercise Capacity and Mortality in Heart Failure With Preserved Ejection Fraction: Insights From Cardiopulmonary Stress Testing
Elshazly, M. B., Senn, T. N., Wu, Y., Lindsay, B. A., Saliba, W. I., Wazni, O. M., & Cho, L. (2017) · Journal of the American Heart Association · doi:10.1161/jaha.117.006662 · Cited by 50
Heart failure subtypes and thromboembolic risk in patients with atrial fibrillation: The PREFER in AF - HF substudy
Siller-Matula, J. M., Pecen, L., Patti, G., Lucerna, M., Kirchhof, P. F., Lesiak, M., Huber, K., Verheugt, F. W. A., Lang, I. M., Renda, G., et al. (2018) · International Journal of Cardiology · doi:10.1016/j.ijcard.2018.04.093 · Cited by 49
“Whereas in our analysis all patients had AF and 39% were also diagnosed with HF, other studies focused on patients who all had been diagnosed with HF, and some had also AF (prevalence ranging from 17% to 65%) [34-36].”
Result
SGLT2 Inhibitors and Their Antiarrhythmic Properties
Kolesnik, E., Scherr, D., Rohrer, U., Benedikt, M., Manninger, M., Sourij, H., & von Lewinski, D. (2022) · International Journal of Molecular Sciences · doi:10.3390/ijms23031678 · Cited by 56
“Indeed, atrial fibrillation is common in heart failure patients and predicts worsened outcomes independent of NYHA class or left ventricular ejection fraction [84], and the risk for new onset atrial fibrillation is increased by approximately 40% in patients with diabetes mellitus [85].”
Background
Ablation vs Medical Therapy in the Setting of Symptomatic Atrial Fibrillation and Left Ventricular Dysfunction
Choi, A. D., Hematpour, K., Kukin, M. L., Mittal, S., & Steinberg, J. S. (2009) · Congestive Heart Failure · doi:10.1111/j.1751-7133.2009.00116.x · Cited by 49
European Heart Rhythm Association/Heart Failure Association joint consensus document on arrhythmias in heart failure, endorsed by the Heart Rhythm Society and the Asia Pacific Heart Rhythm Society
Lip, G. Y. H., Heinzel, F. R., Gaïta, F., González‐Juanatey, J. R., Heuzey, J. Y. L., Potpara, T., Svendsen, J. H., Vos, M. A., Anker, S. D., Coats, A. J. S., et al. (2015) · European Journal of Heart Failure · doi:10.1002/ejhf.338 · Cited by 51
Burden of atrial fibrillation and poor rate control detected by continuous monitoring and the risk for heart failure hospitalization
Sarkar, S., Koehler, J. L., Crossley, G. H., Tang, W. H. W., Abraham, W. T., Warman, E. N., & Whellan, D. J. (2012) · American Heart Journal · doi:10.1016/j.ahj.2012.06.020 · Cited by 49
Effect of Atrial Fibrillation on Long-Term Survival in Patients Hospitalised for Heart Failure with Preserved Ejection Fraction
Ruşinaru, D., Leborgne, L., Peltier, M., & Tribouilloy, C. M. (2008) · European Journal of Heart Failure · doi:10.1016/j.ejheart.2008.04.002 · Cited by 49
Prognostic Value of Left Atrial Strain in Outpatients with De Novo Heart Failure
Sanchís, L., Andrea, R., Falces, C., López‐Sobrino, T., Montserrat, S., Pérez‐Villa, F., Bijnens, B. H., & Sitges, M. (2016) · Journal of the American Society of Echocardiography · doi:10.1016/j.echo.2016.07.012 · Cited by 49
Atrial Remodelling in Heart Failure: Recent Developments and Relevance for Heart Failure with Preserved Ejection Fraction
Hohendanner, F., Messroghli, D., Bode, D., Blaschke, F., Parwani, A. S., Boldt, L., & Heinzel, F. R. (2018) · ESC Heart Failure · doi:10.1002/ehf2.12260 · Cited by 48
“Atrial remodelling is of particular interest in patients with HFpEF,(44) where it has been associated with increased mortality(45) and has been recognized as a hallmark feature of the disease.(44)Melenovsky et al.”
Background
Rhythm vs Rate Control Strategy for Atrial Fibrillation
Zafeiropoulos, S., Doundoulakis, I., Bekiaridou, Α., Farmakis, I. T., Papadopoulos, G. E., Coleman, K. M., Giannakoulas, G. A., Zanos, S. P., Tsiachris, D., Duru, F., et al. (2024) · JACC. Clinical electrophysiology · doi:10.1016/j.jacep.2024.03.006 · Cited by 52
Gender Differences in the Risk of Adverse Outcomes in Patients With Atrial Fibrillation and Heart Failure With Preserved Ejection Fraction
O’Neal, W. T., Sandesara, P. B., Hammadah, M., Venkatesh, S., Samman‐Tahhan, A., Kelli, H. M., & Soliman, E. Z. (2017) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2017.02.045 · Cited by 48
Atrial Fibrillation and Dapagliflozin Efficacy in Patients With Preserved or Mildly Reduced Ejection Fraction
Butt, J. H., Kondo, T., Jhund, P. S., Colet, J. C., de Boer, R. A., Desai, A. S., Hernandez, A. F., Inzucchi, S. E., Janssens, S. P., Kosiborod, M., et al. (2022) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2022.08.718 · Cited by 48
Comorbidities and Differential Diagnosis in Heart Failure with Preserved Ejection Fraction
Campbell, R. T., & McMurray, J. J. V. (2014) · Heart Failure Clinics · doi:10.1016/j.hfc.2014.04.009 · Cited by 47
“Regardless of EF, AF was associated with adverse cardiovascular outcomes in the CHARM program.(59)”
Background
Relationships between maintenance of sinus rhythm and clinical outcomes in patients with heart failure with preserved ejection fraction and atrial fibrillation
Machino‐Ohtsuka, T., Seo, Y., Ishizu, T., Yamamoto, M., Hamada‐Harimura, Y., Machino, T., Yamasaki, H., Sekiguchi, Y., Nogami, A., Aonuma, K., et al. (2019) · Journal of Cardiology · doi:10.1016/j.jjcc.2019.02.014 · Cited by 47
Management of atrial fibrillation: two decades of progress — a scientific statement from the European Cardiac Arrhythmia Society
Lévy, S., Steinbeck, G., Santini, L., Näbauer, M., Penela, D., Kantharia, B. K., Saksena, S. V., & Cappato, R. (2022) · Journal of Interventional Cardiac Electrophysiology · doi:10.1007/s10840-022-01195-z · Cited by 50
SGLT2i effect on atrial fibrillation: A network meta‐analysis of randomized controlled trials
Mariani, M. V., Manzi, G., Pierucci, N., Laviola, D., Piro, A., D’Amato, A., Filomena, D., Matteucci, A., Severino, P., Miraldi, F., et al. (2024) · Journal of Cardiovascular Electrophysiology · doi:10.1111/jce.16344 · Cited by 48
n -3 Polyunsaturated Fatty Acids and Atrial Fibrillation in Patients with Chronic Heart Failure: the GISSI-HF Trial
Aleksova, A., Masson, S., Maggioni, A. P., Lucci, D., Fabbri, G., Beretta, L., Mos, L., Paino, A. M., Nicolosi, G. L., Marchioli, R., et al. (2013) · European Journal of Heart Failure · doi:10.1093/eurjhf/hft103 · Cited by 45
Who Should Receive the Subcutaneous Implanted Defibrillator?
Poole, J. E., & Gold, M. R. (2013) · Circulation Arrhythmia and Electrophysiology · doi:10.1161/circep.113.000481 · Cited by 45
“However, inappropriate therapies are most often because of atrial fibrillation, a known adverse risk predictor in patients with heart failure.(44,45) other causes of inappropriate therapies include supraventricular tachyarrhythmias, oversensing, or artifact.”
Background
Impact of Atrial Fibrillation on Rest and Exercise Haemodynamics in Heart Failure with Mid-Range and Preserved Ejection Fraction
Kaye, D. M., Silvestry, F. E., Gustafsson, F., Cleland, J. G. F., van Veldhuisen, D. J., Ponikowski, P. P., Komtebedde, J., Nanayakkara, S., Burkhoff, D., & Shah, S. J. (2017) · European Journal of Heart Failure · doi:10.1002/ejhf.930 · Cited by 45
Atrial Fibrillation and CHADS2 Risk Factors are Associated with Highly Sensitive C‐Reactive Protein Incrementally and Independently
Crandall, M. A., Horne, B. D., DAY, J. D., Anderson, J. L., Muhlestein, J. B., Crandall, B. G., Weiss, J. P., LAPPE, D. L., & Bunch, T. J. (2009) · Pacing and Clinical Electrophysiology · doi:10.1111/j.1540-8159.2009.02339.x · Cited by 45
Determinants and Prognosis of Atrial Fibrillation in Patients With Aortic Stenosis
Lévy, F., Ruşinaru, D., Maréchaux, S., Charles, V., Peltier, M., & Tribouilloy, C. M. (2015) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2015.08.018 · Cited by 44
Atrial Fibrillation in Congestive Heart Failure
Seiler, J., & Stevenson, W. G. (2009) · Cardiology in Review · doi:10.1097/crd.0b013e3181c21cff · Cited by 44
“This observation was supported by data of the CHARM study, where the presence of AF was associated with increased mortality, with a greater impact in patients with preserved LV function than in patients with a low ejection fraction.(59)”
Method
Atrial Fibrillation and Heart Failure
Ariyaratnam, J., Lau, D. H., Sanders, P., & Kalman, J. M. (2021) · Cardiac Electrophysiology Clinics · doi:10.1016/j.ccep.2020.11.004 · Cited by 44
Tissue Doppler Imaging as a Prognostic Marker for Cardiovascular Events in Heart Failure with Preserved Ejection Fraction and Atrial Fibrillation
Shin, H., Kim, H., Son, J., Yoon, H., Park, H., Cho, Y., Han, C.-D., Nam, C., Hur, S., Kim, Y.-N., et al. (2010) · Journal of the American Society of Echocardiography · doi:10.1016/j.echo.2010.05.003 · Cited by 43
History of Atrial Fibrillation as a Risk Factor in Patients With Heart Failure and Preserved Ejection Fraction
Oluleye, O. W., Rector, T. S., Win, S., McMurray, J. J. V., Zile, M. R., Michel Komajda, N., McKelvie, R. S., Massie, B. M., Carson, P. E., & Anand, I. S. (2014) · Circulation Heart Failure · doi:10.1161/circheartfailure.114.001523 · Cited by 43
Comparative Evaluation of Effect of Valsartan/Amlodipine and Atenolol/Amlodipine Combinations on Atrial Fibrillation Recurrence in Hypertensive Patients With Type 2 Diabetes Mellitus
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Effects of renal sympathetic denervation on the development of atrial fibrillation substrates in dogs with pacing-induced heart failure
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Incidence of paroxysmal atrial tachycardias in patients treated with cardiac resynchronization therapy and continuously monitored by device diagnostics
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Cardiac Resynchronization Therapy in Patients with Permanent Atrial Fibrillation. Is it Mandatory to Ablate the Atrioventricular Junction to Obtain a Good Response?
Tolosana, J. M., Arnau, A. M., Hernández‐Madrid, A., Macı́as, A., Lozano, I. F., Osca, J., Quesada, A., Toquero, J., Francés, R. M., Bolao, I. G., et al. (2012) · European Journal of Heart Failure · doi:10.1093/eurjhf/hfs024 · Cited by 42
Pathophysiology of concomitant atrial fibrillation and heart failure: implications for management
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Atrial fibrillation and the risk of death in patients with heart failure: a literature‐based meta‐analysis
Wasywich, C. A., Pope, A., Somaratne, J., Poppe, K., WHALLEY, G. A., & Doughty, R. N. (2009) · Internal Medicine Journal · doi:10.1111/j.1445-5994.2009.01991.x · Cited by 41
Atrial fibrillation and congestive heart failure
Roy, D., Talajic, M. R., Dubuc, M., Thibault, B., Guerra, P. G., Macle, L., & Khairy, P. (2008) · Current Opinion in Cardiology · doi:10.1097/hco.0b013e32831c8c58 · Cited by 40
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Prevalence and Incidence of Atrial Fibrillation in Ambulatory Patients With Heart Failure
Pellicori, P., Urbinati, A., Kaur, K., Zhang, J., Shah, P. P., Kazmi, S., Capucci, A., Cleland, J. G. F., & Clark, A. L. (2019) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2019.08.018 · Cited by 37
Differential impact of heart rate and blood pressure on outcome in patients with heart failure with reduced versus preserved left ventricular ejection fraction
Maeder, M. T., & Kaye, D. M. (2010) · International Journal of Cardiology · doi:10.1016/j.ijcard.2010.10.007 · Cited by 39
“Given that by a number of complex and incompletely understood mechanisms atrial fibrillation may contribute to higher morbidity and mortality in patients with HF, irrespective of LVEF [34], the exclusion of patients with atrial fibrillation is actually a strength of this analysis on HR and outcome.”
Background
Is cardiac resynchronization therapy an antiarrhythmic therapy for atrial fibrillation? A systematic review and meta-analysis
Hess, P. L., Jackson, K. P., Hasselblad, V., & Al-Khatib, S. M. (2013) · Current Cardiology Reports · doi:10.1007/s11886-012-0330-6 · Cited by 38
Heart failure with preserved and reduced ejection fraction: different risk profiles for different diseases
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BackgroundInfluential
The Emerging Role of Glucagon-like Peptide-1 Receptor Agonists in the Management of Obesity-Related Heart Failure with Preserved Ejection Fraction: Benefits beyond What Scales Can Measure?
Karakasis, P., Fragakis, N., Patoulias, D., Theofilis, P., Sagris, Μ., Koufakis, T., Vlachakis, P. K., Rangraze, I. R., El‐Tanani, M., Tsioufis, K. P., et al. (2024) · Biomedicines · doi:10.3390/biomedicines12092112 · Cited by 37
“Atrial fibrillation (AF) is common in patients with HFpEF, with prevalence rates re-ported to be as high as 65% [72–74]. patients with AF have a more unfavorable prognosis than those in sinus rhythm, with the elevated risk associated with AF being more significant in HFpEF than in HFrEF [75].”
Background
SGLT2i Reduce Arrhythmic Events in Heart Failure Patients with Cardiac Implantable Electronic Devices
Mariani, M. V., Lavalle, C., Palombi, M., Pierucci, N., Trivigno, S., D’Amato, A., Filomena, D., Cipollone, P., Laviola, D., Piro, A., et al. (2025) · ESC Heart Failure · doi:10.1002/ehf2.15223 · Cited by 37
2025 Clinical practice guidelines for Atrial fibrillation and flutter
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Comparison of Mortality and Morbidity in Patients With Atrial Fibrillation and Heart Failure With Preserved Versus Decreased Left Ventricular Ejection Fraction
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Surgery for atrial fibrillation
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Heart rate monitoring on the stroke unit. What does heart beat tell about prognosis? An observational study
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Bucindolol for the Maintenance of Sinus Rhythm in a Genotype-Defined HF Population
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“Development of AF is associated with increased risk of adverse cardiovascular outcomes, and when AF occurs in patients with HF these adverse effects are accentuated (2,3).”
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Hyponatremia is associated with occurrence of atrial fibrillation in outpatients with heart failure and reduced ejection fraction
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“In addition, the incidence of atrial fibrillation is associated with worse prognosis in HFpEF [45].”
Background
Devices in Heart Failure Patients—Who Benefits From ICD and CRT?
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Impact of Atrial Fibrillation on Outcome of Patients with Idiopathic Dilated Cardiomyopathy: Data from the Heart Muscle Disease Registry of Trieste
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“To what extent the presence and development of this arrhythmia retains a prognostic role in patients with heart failure remains debatable.(6-13) To date, few studies have evaluated the predictive value of new onset AF in heart failure populations; the results of which have been contradictory.”
Background
Recent Developments in Understanding Epidemiology and Risk Determinants of Atrial Fibrillation as a Cause of Stroke
Ahmad, Y., Lip, G. Y. H., & Lane, D. A. (2013) · Canadian Journal of Cardiology · doi:10.1016/j.cjca.2013.03.009 · Cited by 33
Severity of Renal Impairment in Patients with Heart Failure and Atrial Fibrillation: Implications for Non-Vitamin K Antagonist Oral Anticoagulant Dose Adjustment
Hawkins, N. M., Jhund, P. S., Pozzi, A., O’Meara, E., Solomon, S. D., Granger, C. B., Yusuf, S., Pfeffer, M. A., Swedberg, K. B., Petrie, M. C., et al. (2016) · European Journal of Heart Failure · doi:10.1002/ejhf.614 · Cited by 33
Insights into the Importance of the Electrocardiogram in Patients with Acute Heart Failure
Gouda, P., Brown, P., Rowe, B. H., McAlister, F. A., & Ezekowitz, J. A. (2016) · European Journal of Heart Failure · doi:10.1002/ejhf.561 · Cited by 33
Outcome in Heart Failure with Preserved Ejection Fraction: The Role of Myocardial Structure and Right Ventricular Performance
Goliasch, G., Zotter‐Tufaro, C., Aschauer, S., Duca, F., Koell, B., Kammerlander, A. A., Ristl, R., Lang, I. M., Maurer, G., Mascherbauer, J., et al. (2015) · PLoS ONE · doi:10.1371/journal.pone.0134479 · Cited by 32
“Furthermore, our patient population represents a more advanced spectrum of patients with HFpEF, which is supported by the high prevalence of atrial fibrillation (62% in our cohort versus 19% in the CHARMHFpEF cohort [26]), the large extent of myocardial fibrosis and relatively high pulmonary pressures.”
Result
Atrial Fibrillation in Heart Failure
Lardizabal, J. A., & DEEDWANIA, P. C. (2012) · Medical Clinics of North America · doi:10.1016/j.mcna.2012.07.007 · Cited by 32
Characteristics, Treatment, and Outcomes of Newly Diagnosed Atrial Fibrillation Patients with Heart Failure: GARFIELD-AF
Ambrosio, G., Camm, A. J., Bassand, J., Corbalan, R. L., Kayani, G., Carluccio, E., Mantovani, L. G., Virdone, S., Kakkar, A. K., & for the GARFIELD-AF Investigators (2021) · ESC Heart Failure · doi:10.1002/ehf2.13156 · Cited by 32
Left Atrial Volume Best Predicts Recurrence after Catheter Ablation in Patients with Persistent and Longstanding Persistent Atrial Fibrillation
Kohári, M., Zado, E. S., Marchlinski, F. E., Callans, D. J., & Han, Y. (2013) · Pacing and Clinical Electrophysiology · doi:10.1111/pace.12279 · Cited by 32
Atrial Fibrillation in Heart Failure is Associated with an Increased Risk of Death Only in Patients with Ischaemic Heart Disease
Raunsø, J., Pedersen, O. D., Domínguez, H., Hansen, M. L., Møller, J. E., Kjærgaard, J., Hassager, C., Torp-Pedersen, C. T., & Køber, L. (2010) · European Journal of Heart Failure · doi:10.1093/eurjhf/hfq052 · Cited by 32
“Most previous studies have focused on HF patients with reduced LVEF even though it is recognized that preserved systolic function may be found in up to 50% of HF patients.25 A recent study designed to investigate the impact of AF on mortality in HF patients with preserved systolic function failed to identify AF as an…”
Result
Prediction of Long‐Term Outcomes of Catheter Ablation of Persistent Atrial Fibrillation by Parameters of Preablation DC Cardioversion
Kang, J. H., Lee, D. I., Kim, S., Kim, M., Park, Y. M., Ban, J., Choi, J., Lim, H. E., Park, S. W., & Kim, Y. (2012) · Journal of Cardiovascular Electrophysiology · doi:10.1111/j.1540-8167.2012.02339.x · Cited by 31
Anemia as an Independent Predictor of Adverse Cardiac Outcomes in Patients with Atrial Fibrillation
Lee, W.-H., Hsu, P., Chu, C., Lee, H.-H., Lee, M.-K., Lee, C., Yen, H., Lin, T., Voon, W., Lai, W., et al. (2015) · International Journal of Medical Sciences · doi:10.7150/ijms.11924 · Cited by 31
“Additionally, left ventricular systolic and diastolic dysfunction [22, 42, 43,44-46], and left ventricular hypertrophy [47] were significantly associated with high risks of cardiovascular morbidity and mortality in patients with AF.”
Background
Antithrombotic therapy in heart failure patients with and without atrial fibrillation: update and future challenges
Ferreira, J. P., Girerd, N., Alshalash, S., Konstam, M. A., & Zannad, F. M. (2016) · European Heart Journal · doi:10.1093/eurheartj/ehw213 · Cited by 31
Impact of Arrhythmias on Hospitalizations in Patients With Cardiac Amyloidosis
Thakkar, S. J., Patel, H., Chowdhury, M., Patel, K., Kumar, A., Arora, S., Zahid, S., Goel, M., Barssoum, K. N., Jain, V., et al. (2020) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2020.12.024 · Cited by 31
Outcomes Following Heart Failure Hospitalization in a Regional Australian Setting Between 2005 and 2014
Al-Omary, M. S., Khan, A. A., Davies, A. J., Fletcher, P., McIvor, D., Bastian, B. C., Oldmeadow, C. J., Sverdlov, A. L., Attia, J., & Boyle, A. (2017) · ESC Heart Failure · doi:10.1002/ehf2.12239 · Cited by 30
“These shifting demographics highlight the importance of involving geriatric medicine in HF management.7,24 The 30 day and 1 year all-cause readmission rates were 20% and 58%, respectively, with nearly half of all readmissions due to HF.”
BackgroundInfluential
SGLT2 inhibitors: an evidence-based update on cardiovascular implications
Forzano, I., Wilson, S. M., Lombardi, A., Jankauskas, S. S., Kansakar, U., Mone, P., Varzideh, F., & Santulli, G. (2023) · Expert Opinion on Investigational Drugs · doi:10.1080/13543784.2023.2263354 · Cited by 33
“The effects of SGLT2 inhibitors are also being investigated on the incidence of atrial fibrillation (AF), an aspect particularly relevant if we consider that AF is more frequent in patients with HF and in patients with diabetes [79,80].”
Background
Prognostic Impact of New-Onset Atrial Fibrillation in Patients With Chronic Heart Failure – A Report From the CHART-2 Study –
Yamauchi, T., Sakata, Y., Miura, M., Tadaki, S., Ushigome, R., Sato, K., Onose, T., Tsuji, K., Abe, R., Oikawa, T., et al. (2015) · Circulation Journal · doi:10.1253/circj.cj-15-0783 · Cited by 30
National Trends in the Burden of Atrial Fibrillation During Hospital Admissions for Heart Failure
Reinhardt, S. W., Chouairi, F. K., Miller, P. E., Clark, K. A. A., Kay, B., Fuery, M. A., Guha, A., Freeman, J. V., Ahmad, T., Desai, N. R., et al. (2021) · Journal of the American Heart Association · doi:10.1161/jaha.120.019412 · Cited by 30
Heart Failure with Normal Ejection Fraction
Tschöpe, C., & Westermann, D. (2009) · Herz · doi:10.1007/s00059-009-3197-6 · Cited by 30
“LA enlargement will increase the risk of atrial fibrillation (another surrogate of diastolic dysfunction), a factor which seems to have an impact on mortality and morbidity, especially in patients with HFNEF [21].”

Authors: Olsson, L. G., Swedberg, K., Ducharme, A., Granger, C. B., Michelson, E. L., McMurray, J. J. V., Puu, M., Yusuf, S., & Pfeffer, M. A.
Affiliations: Sahlgrenska University Hospital (SE)
Montreal Heart Institute (CA)
Duke Medical Center (US)
AstraZeneca (United States) (US)
Western Infirmary (GB)
AstraZeneca (Sweden) (SE)
Brigham and Women's Hospital (US)
Corresponding author: Swedberg, Karl
ORCID: Swedberg, Karl
Ducharme, Anique
Granger, Christopher B.
McMurray, John J.V.
Yusuf, Salim
Pfeffer, Marc A.
Venue: Journal of the American College of Cardiology
Publisher: Elsevier BV
Published: 2006-05
Volume: 47
Issue: 10
Pages: 1997-2004
ISSN: 0735-1097 (ISSN-L)
DOI: 10.1016/j.jacc.2006.01.060
OpenAlex: W104425974
Cited by: 574
References: 35
Citations by year: 2026: 17 · 2025: 25 · 2024: 26 · 2023: 17 · 2022: 18 · 2021: 37 · 2020: 33 · 2019: 24 · 2018: 22 · 2017: 39 · 2016: 37 · 2015: 32 · 2014: 25 · 2013: 44 · 2012: 29
FWCI: 23.22
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/open-access/userlicense/1.0/ (vor, 2670 d)
Locations: Journal of the American College of Cardiology (publishedVersion)
PubMed (publishedVersion)
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 Health and Mental Health
Keywords: atrial fibrillation, chronic heart failure, left ventricular systolic dysfunction, preserved ejection fraction, candesartan, cardiovascular mortality, hospitalization for worsening heart failure, all-cause mortality, CHARM trial, angiotensin receptor blockers
MeSH terms: Aged, Atrial Fibrillation, Benzimidazoles, Biphenyl Compounds, Cardiovascular Diseases, Chronic Disease, Female, Heart Failure, Hospitalization, Humans, Male, Middle Aged, Prognosis, Risk, Stroke Volume, Tetrazoles, Ventricular Dysfunction, Left, Angiotensin II Type 1 Receptor Blockers

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Atrial Fibrillation and Risk of Clinical Events in Chronic Heart Failure With and Without Left Ventricular Systolic Dysfunction

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