Cited by 1,970Atrial Fibrillation Management and OutcomesHeart Failure Treatment and ManagementCardiac Health and Mental Health

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Temporal Relations of Atrial Fibrillation and Congestive Heart Failure and Their Joint Influence on Mortality: The Framingham Heart Study

Wang, Thomas J., Larson, Martin G., Levy, Daniel, Vasan, Ramachandran S., Leip, Eric P., Wolf, Philip A., D’Agostino, Ralph B., Murabito, Joanne M., Kannel, William B., Benjamin, Emelia J.·2003·Circulation

DOI 10.1161/01.cir.0000072767.89944.6e

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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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Background
Electrical Remodeling of the Atria in Congestive Heart Failure
Sanders, P., Morton, J. B., Davidson, N. C., Spence, S. J., Vohra, J. K., SPARKS, P. B., & Kalman, J. M. (2003) · Circulation · doi:10.1161/01.cir.0000090688.49283.67 · Cited by 622
“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…”
Method
Atrial fibrillation in acute myocardial infarction: a systematic review of the incidence, clinical features and prognostic implications
Schmitt, J., Duray, G. Z., Gersh, B. J., & Hohnloser, S. H. (2008) · European Heart Journal · doi:10.1093/eurheartj/ehn579 · Cited by 613
“Wang et al.(9) described a strong relation of AF and CHF on mortality in the Framingham population.”
Background
Efficacy of β blockers in patients with heart failure plus atrial fibrillation: an individual-patient data meta-analysis
Kotecha, D., Holmes, J., Krum, H., Altman, D. G., Manzano, L., Cleland, J. G. F., Lip, G. Y. H., Coats, A. J. S., Andersson, B., Kirchhof, P., et al. (2014) · The Lancet · doi:10.1016/s0140-6736(14)61373-8 · Cited by 579
Atrial Fibrillation and Risk of Clinical Events in Chronic Heart Failure With and Without Left Ventricular Systolic Dysfunction
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2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: Executive Summary
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Incidence and Prevalence of Atrial Fibrillation and Associated Mortality Among Medicare Beneficiaries: 1993–2007
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Self-citation
Lifestyle and Risk Factor Modification for Reduction of Atrial Fibrillation: A Scientific Statement From the American Heart Association
Chung, M. K., Eckhardt, L. L., Chen, L. Y., Ahmed, H. M., Gopinathannair, R., Joglar, J. A., Noseworthy, P. A., Pack, Q. R., Sanders, P., & Trulock, K. M. (2020) · Circulation · doi:10.1161/cir.0000000000000748 · Cited by 565
A Randomized Controlled Trial of Catheter Ablation Versus Medical Treatment of Atrial Fibrillation in Heart Failure (The CAMTAF Trial)
Hunter, R. J., Berriman, T., Diab, I. G., Kamdar, R., Richmond, L., Baker, V., Goromonzi, F., Sawhney, V., Duncan, E. R., Page, S. P., et al. (2014) · Circulation Arrhythmia and Electrophysiology · doi:10.1161/circep.113.000806 · Cited by 504
“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…”
Background
A randomized trial to assess catheter ablation versus rate control in the management of persistent atrial fibrillation in heart failure
Jones, D. G., Haldar, S. K., Hussain, W., Sharma, R., Francis, D. P., Rahman-Haley, S. L., McDonagh, T. A., Underwood, S. R., Markides, V., & Wong, T. (2013) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2013.01.069 · Cited by 481
“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).”
Background
Prevention of Atrial Fibrillation
Benjamin, E. J., Chen, P., Bild, D. E., Mascette, A. M., Albert, C. M., Alonso, Á., Calkins, H. G., Connolly, S. J., Curtis, A. B., Darbar, D., et al. (2009) · Circulation · doi:10.1161/circulationaha.108.825380 · Cited by 477
Self-citation
The CONNECT (Clinical Evaluation of Remote Notification to Reduce Time to Clinical Decision) Trial
Crossley, G. H., Boyle, A., Vitense, H., Chang, Y., & Mead, R. H. (2011) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2010.12.012 · Cited by 526
ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation
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Atrial Fibrillation and the Risk of Myocardial Infarction
Soliman, E. Z., Safford, M. M., Muntner, P., Khodneva, Y. A., Dawood, F. Z., Zakai, N. A., Thacker, E. L., Judd, S. E., Howard, V. J., Howard, G., et al. (2013) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2013.11912 · Cited by 471
Atrial Fibrillation Burden: Moving Beyond Atrial Fibrillation as a Binary Entity: A Scientific Statement From the American Heart Association
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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…”
Background
Mortality Trends in Patients Diagnosed With First Atrial Fibrillation
Miyasaka, Y., Barnes, M. E., Bailey, K. R., Cha, S. S., Gersh, B. J., Seward, J. B., & Tsang, T. S. M. (2007) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2006.10.062 · Cited by 411
Long-Term Progression and Outcomes With Aging in Patients With Lone Atrial Fibrillation: A 30-Year Follow-Up Study
Jahangir, A., Lee, V., Friedman, P. A., Trusty, J. M., Hodge, D. O., Kopecky, S. L., Packer, D. L., Hammill, S. C., Shen, W.-K., & Gersh, B. J. (2007) · Circulation · doi:10.1161/circulationaha.106.644484 · Cited by 392
The impact of atrial fibrillation type on the risk of thromboembolism, mortality, and bleeding: a systematic review and meta-analysis
Ganesan, A. N., Chew, D. P., Hartshorne, T., Selvanayagam, J. B., Aylward, P. E., Sanders, P., & McGavigan, A. D. (2016) · European Heart Journal · doi:10.1093/eurheartj/ehw007 · Cited by 394
Four-Year Efficacy of Cardiac Resynchronization Therapy on Exercise Tolerance and Disease Progression
Gasparini, M., Auricchio, A., Regoli, F. D., Fantoni, C., Kawabata, M., Galimberti, P., Pini, D., Ceriotti, C., Gronda, E., Klersy, C., et al. (2006) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2006.03.056 · Cited by 379
Temporal Relationship and Prognostic Significance of Atrial Fibrillation in Heart Failure Patients With Preserved Ejection Fraction
Zakeri, R., Chamberlain, A. M., Roger, V. L., & Redfield, M. M. (2013) · Circulation · doi:10.1161/circulationaha.113.001475 · Cited by 370
Pulmonary vein isolation for the treatment of atrial fibrillation in patients with impaired systolic function
Chen, M. S., Marrouche, N. F., Khaykin, Y., Gillinov, A. M., Wazni, O. M., Martin, D. O., Rossillo, A., Verma, A., Cummings, J. E., Erciyes, D., et al. (2004) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2003.09.056 · Cited by 370
Atrial fibrillation in heart failure: what should we do?
Kotecha, D., & Piccini, J. P. (2015) · European Heart Journal · doi:10.1093/eurheartj/ehv513 · Cited by 378
Atrial‐like cardiomyocytes from human pluripotent stem cells are a robust preclinical model for assessing atrial‐selective pharmacology
Devalla, H. D., Schwach, V., Ford, J. W., Milnes, J. T., El-Haou, S., Jackson, C., Gkatzis, K., Elliott, D. A., Lopes, S. M. C. D. S., Mummery, C. L., et al. (2015) · EMBO Molecular Medicine · doi:10.15252/emmm.201404757 · Cited by 354
“However, current preclinical studies carried out in noncardiac cell lines or animal models may not accurately represent the physiology of a human cardiomyocyte (CM).”
Background
Status of the Epidemiology of Atrial Fibrillation
Kannel, W. B., & Benjamin, E. J. (2007) · Medical Clinics of North America · doi:10.1016/j.mcna.2007.09.002 · Cited by 359
Self-citation
[Guidelines for the management of patients with atrial fibrillation. Executive summary].
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., Lowe, J. E., et al. (2006) · PubMed · Cited by 356
Atrial fibrillation in women: epidemiology, pathophysiology, presentation, and prognosis
Ko, D., Rahman, F., Schnabel, R. B., Yin, X., Benjamin, E. J., & Christophersen, I. E. (2016) · Nature Reviews Cardiology · doi:10.1038/nrcardio.2016.45 · Cited by 353
Self-citation
Radiofrequency ablation for persistent atrial fibrillation in patients with advanced heart failure and severe left ventricular systolic dysfunction: a randomised controlled trial
MacDonald, M. R., Connelly, D. T., Hawkins, N. M., Steedman, T., Payne, J., Shaw, M., Denvir, M., Bhagra, S. K., Small, A. D., Martin, W., et al. (2010) · Heart · doi:10.1136/hrt.2010.207340 · Cited by 349
“The presence of AF in heart failure is associated with increased morbidity and mortality.”
Background
Risk of Death and Cardiovascular Events in Initially Healthy Women With New-Onset Atrial Fibrillation
Conen, D. (2011) · JAMA · doi:10.1001/jama.2011.659 · Cited by 349
Cardiac resynchronization therapy and the relationship of percent biventricular pacing to symptoms and survival
Hayes, D. L., BOEHMER, J. P., Day, J. D., Gilliam, F. R., Heidenreich, P. A., Seth, M., Jones, P. W., & Saxon, L. A. (2011) · Heart Rhythm · doi:10.1016/j.hrthm.2011.04.015 · Cited by 349
ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation—Executive Summary
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., Lowe, J. E., et al. (2006) · Circulation · doi:10.1161/circulationaha.106.177031 · Cited by 345
Asymptomatic Atrial Fibrillation: Clinical Correlates, Management, and Outcomes in the EORP-AF Pilot General Registry
Boriani, G., Laroche, C., Diemberger, I., Fantecchi, E., Popescu, M. I., Rasmussen, L. H., Sinagra, G., Petrescu, L., Tavazzi, L., Maggioni, A. P., et al. (2014) · The American Journal of Medicine · doi:10.1016/j.amjmed.2014.11.026 · Cited by 344
“Fully asymptomatic atrial fibrillation is associated with the highest median age, as well as chronic heart failure (25).”
Background
Mortality Associated With Atrial Fibrillation in Patients With Myocardial Infarction: A Systematic Review and Meta-Analysis
Jabre, P., Roger, V. L., Murad, M. H., Chamberlain, A. M., Prokop, L., Adnet, F., & Jouven, X. (2011) · Circulation · doi:10.1161/circulationaha.110.986661 · Cited by 314
Upstream therapies for management of atrial fibrillation: review of clinical evidence and implications for European Society of Cardiology guidelines. Part I: primary prevention
Savelieva, I., Kakouros, N., Kourliouros, A., & Camm, A. J. (2011) · EP Europace · doi:10.1093/europace/eur002 · Cited by 315
Influence of Systolic and Diastolic Blood Pressure on the Risk of Incident Atrial Fibrillation in Women
Conen, D., Tedrow, U. B., Koplan, B. A., Glynn, R. J., Buring, J. E., & Albert, C. M. (2009) · Circulation · doi:10.1161/circulationaha.108.830042 · Cited by 312
70-year legacy of the Framingham Heart Study
Andersson, C., Johnson, A. D., Benjamin, E. J., Levy, D., & Vasan, R. S. (2019) · Nature Reviews Cardiology · doi:10.1038/s41569-019-0202-5 · Cited by 305
Self-citation
Sex differences in cardiac arrhythmia: a consensus document of the European Heart Rhythm Association, endorsed by the Heart Rhythm Society and Asia Pacific Heart Rhythm Society
Linde, C. M., Bongiorni, M. G., Birgersdotter-Green, U. M., Curtis, A. B., Deisenhofer, I., Furokawa, T., Gillis, A. M., Haugaa, K. H., Lip, G. Y. H., Gelder, I. C. V., et al. (2018) · EP Europace · doi:10.1093/europace/euy067 · Cited by 308
“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…”
Background
Two-year outcomes of patients with newly diagnosed atrial fibrillation: results from GARFIELD-AF
Bassand, J., Accetta, G., Camm, A. J., Cools, F. J. S., Fitzmaurice, D. A., Fox, K. A. A., Goldhaber, S. Z., Goto, S., Haas, S. K., Hacke, W., et al. (2016) · European Heart Journal · doi:10.1093/eurheartj/ehw233 · Cited by 288
Atrial fibrillation in the Malmö diet and cancer study: a study of occurrence, risk factors and diagnostic validity
Smith, J. G., Platonov, P. G., Hedblad, B., Engström, G., & Melander, O. (2010) · European Journal of Epidemiology · doi:10.1007/s10654-009-9404-1 · Cited by 275
Heart Failure Decompensation and All-Cause Mortality in Relation to Percent Biventricular Pacing in Patients With Heart Failure
Koplan, B. A., Kaplan, A. J., Weiner, S., Jones, P. W., Seth, M., & Christman, S. A. (2009) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2008.09.043 · Cited by 274
Regression of Electrocardiographic Left Ventricular Hypertrophy and Decreased Incidence of New-Onset Atrial Fibrillation in Patients With Hypertension
Okin, P. M., Wachtell, K., Devereux, R. B., Harris, K. E., Jern, S., Kjeldsen, S. E., Julius, S., Lindholm, L. H., Nieminen, M. S., Edelman, J. M., et al. (2006) · JAMA · doi:10.1001/jama.296.10.1242 · Cited by 268
Long-term survival in patients undergoing cardiac resynchronization therapy: the importance of performing atrio-ventricular junction ablation in patients with permanent atrial fibrillation
Gasparini, M., Auricchio, A., Metra, M., Regoli, F. D., Fantoni, C., Lamp, B., Curnis, A., Vogt, J., & Klersy, C. (2008) · European Heart Journal · doi:10.1093/eurheartj/ehn133 · Cited by 259
Analysis of Stroke in ATHENA: A Placebo-Controlled, Double-Blind, Parallel-Arm Trial to Assess the Efficacy of Dronedarone 400 mg BID for the Prevention of Cardiovascular Hospitalization or Death From Any Cause in Patients With Atrial Fibrillation/Atrial Flutter
Connolly, S. J., Crijns, H. J. G. M., Torp-Pedersen, C. T., van Eickels, M., Gaudin, C., Page, R. L., & Hohnloser, S. H. (2009) · Circulation · doi:10.1161/circulationaha.109.875252 · Cited by 259
Catheter ablation for atrial fibrillation: current indications and evolving technologies
Parameswaran, R., Al‐Kaisey, A., & Kalman, J. M. (2020) · Nature Reviews Cardiology · doi:10.1038/s41569-020-00451-x · Cited by 261
Atrial Fibrillation
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Self-citation
Lifetime Risk of Atrial Fibrillation by Race and Socioeconomic Status
Mou, L., Norby, F. L., Chen, L. Y., O’Neal, W. T., Lewis, T. T., Loehr, L. R., Soliman, E. Z., & Alonso, Á. (2018) · Circulation Arrhythmia and Electrophysiology · doi:10.1161/circep.118.006350 · Cited by 248
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Early Rhythm Control Therapy in Patients With Atrial Fibrillation and Heart Failure
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Atrial fibrillation
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Association Between Titin Loss-of-Function Variants and Early-Onset Atrial Fibrillation
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Self-citation
Epidemiology of Stroke
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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: Wang, Thomas J.
Larson, Martin G.
Levy, Daniel
Vasan, Ramachandran S.
Wolf, Philip A.
D’Agostino, Ralph B.
Murabito, Joanne M.
Benjamin, Emelia J.
Venue: Circulation
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2003-06-17
Volume: 107
Issue: 23
Pages: 2920-2925
ISSN: 0009-7322 (ISSN-L)
1524-4539
DOI: 10.1161/01.cir.0000072767.89944.6e
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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Temporal Relations of Atrial Fibrillation and Congestive Heart Failure and Their Joint Influence on Mortality: The Framingham Heart Study

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