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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, 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]
In the citing paper
“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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“A strong association has been observed between AF and hard clinical endpoints in patients with HF. 69,70 Unrecognized AF may exacerbate HF, increase frequency of hospitalizations, lead to loss of cardiac resynchronization therapy (CRT) and inappropriate ICD shocks, increase sympathetic tone, and induce haemodynamic co…”
BackgroundInfluentialIs atrial fibrillation associated with poor outcome after thrombolysis?
Šaňák, D., Herzig, R., Král, M., Bártková, A., Zapletalová, J., Hutyra, M., Školoudík, D., Vlachová, I., Veverka, T., Hořák, D., et al. (2010) · Journal of Neurology · doi:10.1007/s00415-010-5452-4 · Cited by 57
“is often related to congestive heart failure, which also increases mortality in patients with AF [27, 28].”
BackgroundAtrial Fibrillation, Cognitive Decline, and Dementia: an Epidemiologic Review
Ding, M., & Qiu, C. (2018) · Current Epidemiology Reports · doi:10.1007/s40471-018-0159-7 · Cited by 57
Emerging Antiarrhythmic Drugs for Atrial Fibrillation
Saljic, A., Heijman, J., & Dobrev, D. (2022) · International Journal of Molecular Sciences · doi:10.3390/ijms23084096 · Cited by 60
“Although AF is not an immediately life-threatening arrhythmia, it is associated with a number of clinically relevant complications such as an increased risk of stroke and heart failure, which contribute to the high morbidity and mortality rates amongst AF patients [2,3].”
BackgroundAtrial fibrillation in heart failure: High mortality risk even if ventricular function is preserved
Parkash, R., Maisel, W. H., Toca, F. M., & Stevenson, W. G. (2005) · American Heart Journal · doi:10.1016/j.ahj.2004.12.014 · Cited by 58
Spinal cord stimulation protects against atrial fibrillation induced by tachypacing
Bernstein, S., Wong, B., Vásquez, C., Rosenberg, S. P., Rooke, R., Kuznekoff, L. M., Lader, J. M., Mahoney, V. M., Budylin, T., Älvstrand, M., et al. (2012) · Heart Rhythm · doi:10.1016/j.hrthm.2012.04.038 · Cited by 56
Eicosapentaenoic acid prevents atrial fibrillation associated with heart failure in a rabbit model
Kitamura, K., Shibata, R., Tsuji, Y., Shimano, M., Inden, Y., & Murohara, T. (2011) · American Journal of Physiology-Heart and Circulatory Physiology · doi:10.1152/ajpheart.00771.2010 · Cited by 57
“ATRIAL FIBRILLATION (AF) is common in patients with heart failure (HF) and is associated with increased morbidity and risk of mortality in patients with HF (41).”
BackgroundPathophysiology of Atrial Fibrillation and Heart Failure
Sugumar, H., Nanayakkara, S., Prabhu, S., Voskoboinik, A., Kaye, D. M., Ling, L., & Kistler, P. M. (2019) · Cardiology Clinics · doi:10.1016/j.ccl.2019.01.002 · Cited by 60
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Multiple Biomarkers and Atrial Fibrillation in the General Population
Schnabel, R. B., Wild, P. S., Wilde, S., Ojeda, F., Schulz, A., Zeller, T., Sinning, C., Kunde, J., Lackner, K. J., Münzel, T. F., et al. (2014) · PLoS ONE · doi:10.1371/journal.pone.0112486 · Cited by 55
“Heart failure is an underlying disease in up to 50 percent of AF patients [43] and observed biomarker associations may be due to heart failure.”
BackgroundAmbale‐Venkatesh, B., Armstrong, A. D. C., Liu, C.-Y., Donekal, S., Yoneyama, K., Wu, C. O., Gomes, A. S., Hundley, G. W., Bluemke, D. A., & Lima, J. A. C. (2013) · European Heart Journal - Cardiovascular Imaging · doi:10.1093/ehjci/jet189 · Cited by 55
“The combined end-point was ascertained as the first-documented event of either HF or AF.”
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Pokushalov, E. A., Romanov, A. B., Melis, M. D., Николаевич, А. С., Викторовна, Б. В., Losik, D., Байрамова, С. А., Karaskov, A. M., Mittal, S., & Steinberg, J. S. (2013) · Circulation Arrhythmia and Electrophysiology · doi:10.1161/circep.113.000495 · Cited by 55
Jung, S., Sun, W., Griffiths, L. G., & Kittleson, M. D. (2015) · Journal of Veterinary Internal Medicine · doi:10.1111/jvim.13800 · Cited by 55
Prevalence and prognostic relevance of atrial fibrillation in patients with Takotsubo syndrome
Stiermaier, T., Santoro, F., Eitel, C., Graf, T., Møller, C. H., Tarantino, N. M., Guastafierro, F., Biase, M. D., Thiele, H., Brunetti, N. D., et al. (2017) · International Journal of Cardiology · doi:10.1016/j.ijcard.2017.07.053 · Cited by 55
Cornwell, W., Ambardekar, A., Tran, T., Pal, J., Cava, L. F., Lawley, J., Tarumi, T., Cornwell, C., & Aaronson, K. (2019) · Stroke · doi:10.1161/strokeaha.118.022967 · Cited by 51
Predictive Classifier for Cardiovascular Disease Based on Stacking Model Fusion
Liu, J., Dong, X., Zhao, H., & Tian, Y. (2022) · Processes · doi:10.3390/pr10040749 · Cited by 62
Clonal haematopoiesis of indeterminate potential and atrial fibrillation: an east Asian cohort study
Ahn, H., An, H. Y., Ryu, G., Lim, J., Sun, C.-H., Song, H., Choi, S., Lee, H., Maurer, T. M., Nachun, D. C., et al. (2024) · European Heart Journal · doi:10.1093/eurheartj/ehad869 · Cited by 60
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
Boriani, G., Gasparini, M., Landolina, M., Lunati, M., Proclemer, A., LONARDI, G., Iacopino, S., Rahue, W., Biffi, M., DiStefano, P., et al. (2011) · European Journal of Heart Failure · doi:10.1093/eurjhf/hfr046 · Cited by 54
Almendro‐Delia, M., Valle-Caballero, M. J., García-Rubira, J. C., Muñoz-Calero, B., García-Alcántara, Á., Reina-Toral, A., Benítez-Parejo, J., Hidalgo-Urbano, R. J., & on behalf of the ARIAM Andalucia Study Group (2013) · European Heart Journal Acute Cardiovascular Care · doi:10.1177/2048872613517370 · Cited by 54
Lu, Y., Cheng, C., Chen, Y., Lin, Y., Chen, S.-A., & Chen, Y.-J. (2015) · Heart Rhythm · doi:10.1016/j.hrthm.2015.12.005 · Cited by 54
Gasparini, M., Kloppe, A., Lunati, M., Anselme, F., Landolina, M., Martínez-Ferrer, J., Proclemer, A., Morani, G., Biffi, M., Ricci, R. P., et al. (2017) · European Journal of Heart Failure · doi:10.1002/ejhf.1117 · Cited by 55
Mechanisms and Clinical Significance of Arrhythmia-Induced Cardiomyopathy
Raymond-Paquin, A., Nattel, S., Wakili, R., & Tadros, R. (2018) · Canadian Journal of Cardiology · doi:10.1016/j.cjca.2018.07.475 · Cited by 56
“In the Framingham Heart Study, 21% of the individuals having AF and HF had both conditions diagnosed on the same day.(55) A component of AIC should be suspected whenever LV dysfunction is out of proportion to the extent of underlying heart disease.”
BackgroundFactors impacting complication rates for catheter ablation of atrial fibrillation from 2003 to 2015
Yang, E., İpek, E. G., Balouch, M. A., Mints, Y. Y., Chrispin, J., Marine, J. E., Berger, R. D., Ashikaga, H., Rickard, J., Calkins, H. G., et al. (2016) · EP Europace · doi:10.1093/europace/euw178 · Cited by 53
Rate Control in Atrial Fibrillation
Heist, E. K., MANSOUR, M. C., & Ruskin, J. N. (2011) · Circulation · doi:10.1161/circulationaha.111.019919 · Cited by 53
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
A Support Vector Machine approach for reliable detection of atrial fibrillation events
Colloca, R., Johnson, A. E. W., Mainardi, L. T., & Clifford, G. D. (2013) · Virtual Community of Pathological Anatomy (University of Castilla La Mancha) · Cited by 53
Metadata
- 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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