Temporal Relations of Atrial Fibrillation and Congestive Heart Failure and Their Joint Influence on Mortality: The Framingham Heart Study
Abstract
Background— Atrial fibrillation (AF) and congestive heart failure (CHF) frequently occur together, but there is limited information regarding their temporal relations and the combined influence of these conditions on mortality. Methods and Results— We studied participants in the Framingham Study with new-onset AF or CHF. Multivariable Cox proportional hazards models with time-dependent variables were used to evaluate whether mortality after AF or CHF was affected by the occurrence and timing of the other condition. Hazard ratios (HRs) were adjusted for time period and cardiovascular risk factors. During the study period, 1470 participants developed AF, CHF, or both. Among 382 individuals with both conditions, 38% had AF first, 41% had CHF first, and 21% had both diagnosed on the same day. The incidence of CHF among AF subjects was 33 per 1000 person-years, and the incidence of AF among CHF subjects was 54 per 1000 person-years. In AF subjects, the subsequent development of CHF was associated with increased mortality (men: HR 2.7; 95% CI, 1.9 to 3.7; women: HR 3.1; 95% CI, 2.2 to 4.2). Similarly, in CHF subjects, later development of AF was associated with increased mortality (men: HR 1.6; 95% CI, 1.2 to 2.1; women: HR 2.7, 95% CI, 2.0 to 3.6). Preexisting CHF adversely affected survival in individuals with AF, but preexisting AF was not associated with adverse survival in those with CHF. Conclusions— Individuals with AF or CHF who subsequently develop the other condition have a poor prognosis. Additional studies addressing the pathogenesis, prevention, and optimal management of the joint occurrence of AF and CHF appear warranted.
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In adjusted models, atrial fibrillation is associated with increased morbidity, especially stroke and heart failure, as well as increased mortality.
“In adjusted models, AF is associated with increased morbidity, especially stroke and heart failure, as well as increased mortality.2–5”
From Worldwide Epidemiology of Atrial Fibrillation: A Global Burden of Disease 2010 Study (2014) · cites this paper as [5]
Plasma concentrations of C-reactive protein and fibroblast growth factor-23 are higher in women than in men in epidemiological studies.
“The plasma concentrations of the inflammatory marker C-reactive protein143 and of fibroblast growth factor-23144 have been found to be higher in women than in men in epidemiological studies.”
From Atrial fibrillation in women: epidemiology, pathophysiology, presentation, and prognosis (2016) · cites this paper as [143]
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Authors Task Force Members, Fuster, V., Rydén, L., Cannom, D. S., Crijns, H. J. G. M., Curtis, A. B., Ellenbogen, K. A., Halperin, J. L., Heuzey, J. L., Kay, G. N., et al. (2006) · European Heart Journal · doi:10.1093/eurheartj/ehl176 · Cited by 645 · see citing works
“HF promotes AF, AF aggravates HF, and individuals with either condition who develop the alternate condition share a poor prognosis.(22) Thus, managing patients with the associated conditions is a major challenge, and randomized trials are needed to investigate the impact of AF on prognosis in HF.”
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“point in time was 41% in this cohort [75].”
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“Multipolar catheters were positioned as follows: (1) 10-pole catheter with 2-5-2-mm interelectrode spacing in the coronary sinus (CS) with the proximal electrode pair positioned at the ostium of the CS; (2) 20-pole catheter with 2-5-2-mm interelectrode spacing placed along the lateral right atrium (LRA), with the firs…”
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“Wang et al.(9) described a strong relation of AF and CHF on mortality in the Framingham population.”
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“Subgroup Analysis and Implications for Patient Selection AF and HF are often diagnosed at the same time, and there is a high incidence of new onset HF in patients with AF.(5) In the ablation group, a third of patients who were codiagnosed with AF and HF had complete resolution of HF, suggesting that their HF may have…”
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“Coexistence of AF with HF is associated with increased hospital stay and mortality (4,5) and further increases the stroke risk from AF 3-fold (6).”
BackgroundPrevention of Atrial Fibrillation
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Self-citationThe CONNECT (Clinical Evaluation of Remote Notification to Reduce Time to Clinical Decision) Trial
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“This scientific statement comprehensively discusses the published literature and knowledge gaps related to (1) methods of defining and measuring AF burden, (2) relationship of AF type or device-detected AF duration to cardiovascular and neurological outcomes, and (3) effect of lifestyle and risk factor modification on…”
BackgroundMortality Trends in Patients Diagnosed With First Atrial Fibrillation
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“However, current preclinical studies carried out in noncardiac cell lines or animal models may not accurately represent the physiology of a human cardiomyocyte (CM).”
BackgroundStatus of the Epidemiology of Atrial Fibrillation
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“Fully asymptomatic atrial fibrillation is associated with the highest median age, as well as chronic heart failure (25).”
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70-year legacy of the Framingham Heart Study
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“9 million males worldwide,(95,96) and growing global AF burden represents a major healthcare problem(97,98) owing to significant AFassociated morbidity including increased risk of stroke and death.(88,99,100) Females with AF are significantly older, with greater comorbidity (Figure 7A), and female sex is included in t…”
BackgroundTwo-year outcomes of patients with newly diagnosed atrial fibrillation: results from GARFIELD-AF
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Self-citationLifetime Risk of Atrial Fibrillation by Race and Socioeconomic Status
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Self-citation
- Authors
- Wang, T. J., Larson, M. G., Levy, D., Vasan, R. S., Leip, E. P., Wolf, P. A., D’Agostino, R. B., Murabito, J. M., Kannel, W. B., & Benjamin, E. J.
- Affiliations
- Boston University (US)
- ORCID
- Venue
- Circulation
- Published
- 2003-06-17
- Volume
- 107
- Issue
- 23
- Pages
- 2920-2925
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W1998083759
- Cited by
- 1,970
- References
- 28
- Citations by year
- 2026: 49 · 2025: 65 · 2024: 114 · 2023: 93 · 2022: 117 · 2021: 137 · 2020: 109 · 2019: 103 · 2018: 120 · 2017: 107 · 2016: 111 · 2015: 115 · 2014: 112 · 2013: 101 · 2012: 84
- FWCI
- 27.01
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (n01hc25195-41-0-1)
- National Heart, Lung, and Blood Institute (K24-HL-04334-01A1, N01‐HC25195, K24HL004334)
- National Institute of Neurological Disorders and Stroke (5-RO1-NS-17950, R01NS017950)
- 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, congestive heart failure, mortality, comorbidities, prognosis, Framingham Heart Study
- MeSH terms
- Aged, Atrial Fibrillation, Female, Follow-Up Studies, Heart Failure, Humans, Male, Massachusetts, Middle Aged, Prognosis, Risk Factors, Cohort Studies, Comorbidity, Incidence, Multivariate Analysis, Proportional Hazards Models, Survival Analysis, Disease Progression
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