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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Impact of Atrial Fibrillation on the Risk of Death: The Framingham Heart Study
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Self-citation
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Background
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Genetic Determinants of Electrocardiographic P-Wave Duration and Relation to Atrial Fibrillation
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Background
Incidental LV LGE on CMR Imaging in Atrial Fibrillation Predicts Recurrence After Ablation Therapy
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Background
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Background
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Background
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Prognostic Impact of Atrial Fibrillation and New Risk Score of Its Onset in Patients at High Risk of Heart Failure ― A Report From the CHART-2 Study ―
Yamauchi, T., Sakata, Y., Miura, M., Onose, T., Tsuji, K., Abe, R., Oikawa, T., Kasahara, S., Sato, M., Nochioka, K., et al. (2017) · Circulation Journal · doi:10.1253/circj.cj-16-0759 · Cited by 27
Preoperative atrial fibrillation portends poor outcomes after coronary bypass graft surgery: A systematic review and meta-analysis
Saxena, A., Virk, S. A., Bowman, S. R. A., Chan, L. C. K., Jeremy, R., & Bannon, P. G. (2017) · Journal of Thoracic and Cardiovascular Surgery · doi:10.1016/j.jtcvs.2017.11.048 · Cited by 27
Tachycardia and Atrial Fibrillation-Related Cardiomyopathies
Keefe, J. A., Garber, R., McCauley, M. D., & Wehrens, X. H. T. (2024) · JACC Heart Failure · doi:10.1016/j.jchf.2023.11.016 · Cited by 26
Quality of Anticoagulation Control in Preventing Adverse Events in Patients With Heart Failure in Sinus Rhythm
Homma, S., Thompson, J. L. P., Qian, M., Ye, S., Tullio, M. R. D., Lip, G. Y. H., Mann, D. L., Sacco, R. L., Levin, B., Pullicino, P. M., et al. (2015) · Circulation Heart Failure · doi:10.1161/circheartfailure.114.001725 · Cited by 26
“It is also known that patients with HF tend to develop AF.(11) As such, it is possible that transient AF may have developed in our patients, as has been noted in patients with unknown cause of stroke, and that embolic events from occult AF may have been prevented by effective anticoagulation.”
Influential
Evaluating the HATCH score for predicting progression to sustained atrial fibrillation in ED patients with new atrial fibrillation
Barrett, T. W., Self, W. H., Wasserman, B. S., McNaughton, C. D., & Darbar, D. (2013) · The American Journal of Emergency Medicine · doi:10.1016/j.ajem.2013.01.020 · Cited by 26
Atrial fibrillation and the risk of ischaemic strokes or intracranial haemorrhages: comparisons of the catheter ablation, medical therapy, and non-atrial fibrillation population
Kim, M. H., Yu, H. T., Kim, J., Kim, T., Uhm, J., Joung, B., Lee, M., & Pak, H.-N. (2020) · EP Europace · doi:10.1093/europace/euaa235 · Cited by 26
The effect of obesity, hypertension, diabetes mellitus, alcohol, and sleep apnea on the risk of atrial fibrillation
Čarná, Z., & Osmancik, P. P. (2021) · Physiological Research · doi:10.33549/physiolres.934744 · Cited by 26
Acacetin as a Potential Protective Compound against Cardiovascular Diseases
Wu, C., Yan, J., & Li, W. (2022) · Evidence-based Complementary and Alternative Medicine · doi:10.1155/2022/6265198 · Cited by 25
“cardiac and extra-cardiac caused by AF significantly increase morbidity and mortality [13, 14].”
Background
Catheter ablation versus medical therapy for atrial fibrillation in patients with heart failure with preserved ejection fraction: A systematic review and meta-analysis
Bulhões, E., Antunes, V., Mazetto, R. A. S. V., Defante, M. L. R., Garcia, A. C., & Guida, C. M. (2024) · Heart Rhythm · doi:10.1016/j.hrthm.2024.04.058 · Cited by 29
Increased late mortality after coronary artery bypass surgery complicated by isolated new-onset atrial fibrillation: A comprehensive propensity-matched analysis
Al‐Shaar, L., Schwann, T. A., Kabour, A., & Habib, R. (2014) · Journal of Thoracic and Cardiovascular Surgery · doi:10.1016/j.jtcvs.2014.05.020 · Cited by 26
Bridging of Chronic Oral Anticoagulation with Enoxaparin in Patients with Atrial Fibrillation: Results from the Prospective BRAVE Registry
Hammerstingl, C., Schmitz, A., Fimmers, R., & Omran, H. (2009) · Cardiovascular Therapeutics · doi:10.1111/j.1755-5922.2009.00099.x · Cited by 25
Arrhythmias and Heart Failure
SALTZMAN, H. E. (2013) · Cardiology Clinics · doi:10.1016/j.ccl.2013.09.005 · Cited by 26
“In the Framingham Heart Study, 1470 subjects developed either new AF or HF from 1948 to 1995, with 383 (26%) developing both.(6) In addition, lifetime risks for developing AF in men and in women who are 40 years or older is 1 in 6 in patients without congestive HF or myocardial infarction (MI), and 1 in 4 in the same…”
Atrioventricular Junction Ablation Followed by Resynchronization Therapy in Patients with Congestive Heart Failure and Atrial Fibrillation (AVERT‐AF) Study Design
Hamdan, M. H., Freedman, R. A., Gilbert, E. M., Dimarco, J., Ellenbogen, K. A., & Page, R. L. (2006) · Pacing and Clinical Electrophysiology · doi:10.1111/j.1540-8159.2006.00502.x · Cited by 26
“The exclusion criteria include: (1) paroxysmal or persistent AF, (2) Class I indication for pacing (including AVJ ablation for poor rate control), (3) ability to walk ≥450 m in 6 minutes, (4) musculoskeletal disorders that prohibit the completion of a 450 m walk, (5) NYHA Class I or IV at the time of enrollment, (6) a…”
Background
Arrhythmias in Dilated Cardiomyopathy
Kumar, S., Stevenson, W. G., & John, R. M. (2015) · Cardiac Electrophysiology Clinics · doi:10.1016/j.ccep.2015.03.005 · Cited by 26
Carotid Atherosclerosis and Incident Atrial Fibrillation
Willeit, K., Pechlaner, R., Egger, G., Weger, S., Oberhollenzer, M., Willeit, J., & Kiechl, S. J. (2013) · Arteriosclerosis Thrombosis and Vascular Biology · doi:10.1161/atvbaha.113.302272 · Cited by 26
Access to alcohol and heart disease among patients in hospital: observational cohort study using differences in alcohol sales laws
Dukes, J. W., Dewland, T. A., Vittinghoff, E., Olgin, J. E., Pletcher, M. J., Hahn, J. A., Gladstone, R. A., & Marcus, G. M. (2016) · BMJ · doi:10.1136/bmj.i2714 · Cited by 26
Impact of Atrial Fibrillation and Heart Failure, Independent of Each Other and in Combination, on Mortality in Community-Dwelling Older Adults
Bajaj, N. S., Bhatia, V., Sanam, K., Ather, S., Hashim, T., Morgan, C. J., Fonarow, G. C., Nanda, N. C., Prabhu, S. D., Adamopoulos, C., et al. (2014) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2014.05.045 · Cited by 25
Quantitative evaluation of atrial radio frequency ablation using intracardiac shear‐wave elastography
Kwiecinski, W., Provost, J., Dubois, R., Sacher, F., Haı̈ssaguerre, M., Legros, M., Nguyen‐Dinh, A., Dufait, R., Tanter, M., & Pernot, M. (2014) · Medical Physics · doi:10.1118/1.4896820 · Cited by 25
Catheter Ablation Compared with Medical Therapy for Atrial Fibrillation with Heart Failure: A Systematic Review and Meta-analysis of Randomized Controlled Trials
Pan, K., Wu, Y., Lee, M., & Ovbiagele, B. I. (2021) · International Journal of Medical Sciences · doi:10.7150/ijms.52257 · Cited by 25
Cost‐Utility of Catheter Ablation for Atrial Fibrillation in Patients with Heart Failure: An Economic Evaluation
Lau, D., Sandhu, R. K., Andrade, J. G., Ezekowitz, J. A., So, H., & Klarenbach, S. W. (2021) · Journal of the American Heart Association · doi:10.1161/jaha.120.019599 · Cited by 25
Effects of Renal Sympathetic Denervation on the Atrial Electrophysiology in Dogs with Pacing‐Induced Heart Failure
Wang, X., Zhao, Q., Deng, H., Wang, X., Guo, Z., DAI, Z., Xiao, J., Wan, P., & Huang, C. (2014) · Pacing and Clinical Electrophysiology · doi:10.1111/pace.12429 · Cited by 26
“1 kg were divided into three groups: (1) the control group (three males and three females), (2) the HF group (four males and four females), and (3) the HF + RSD group (three males and five females).”
Method
Six‐Year Clinical Outcomes After Catheter Ablation of Atrial Fibrillation in Patients With Impaired Left Ventricular Function
Rillig, A., Makimoto, H., Wegner, J., Lin, T., Heeger, C.-H. H., Lemeš, C., Fink, T., Metzner, A., Wißner, E., Mathew, S., et al. (2015) · Journal of Cardiovascular Electrophysiology · doi:10.1111/jce.12765 · Cited by 25
“(1) After 6 years, single-procedure success rates after PVI in patients with reduced LVEF ( 45%) were as low as 35.”
BackgroundMethod
Primary prevention of atrial fibrillation with angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in patients with end-stage renal disease undergoing dialysis
Lin, T., Yang, Y., Liao, M., Tsai, C., Hwang, J., Chiang, F., Chen, P., Lin, J.-L., & Lin, L. (2015) · Kidney International · doi:10.1038/ki.2015.96 · Cited by 25
Novel use of the ultra-short-acting intravenous β1-selective blocker landiolol for supraventricular tachyarrhythmias in patients with congestive heart failure
Adachi, T., Sato, A., Baba, M., Hiraya, D., Hasegawa, T., Kuroki, K., Hoshi, T., & Aonuma, K. (2013) · Heart and Vessels · doi:10.1007/s00380-013-0377-3 · Cited by 25
“The largest studies suggest that patients with HF and supraventricular tachyarrhythmias (SVTs) in general, and AF in particular, have increased rates of HF exacerbation, hospitalisation for HF, and death [5, 6].”
Background
Septal flash predicts cardiac resynchronization therapy response in patients with permanent atrial fibrillation
Gabrielli, L., Marincheva, G., Bijnens, B. H., Doltra, A., Tolosana, J. M., Borràs, R., Castel, M., Berruezo, A., Brugada, J., Mont, L., et al. (2014) · EP Europace · doi:10.1093/europace/euu023 · Cited by 25
Association of Peripheral Artery Disease With Incident Atrial Fibrillation: The ARIC (Atherosclerosis Risk in Communities) Study
Bekwelem, W., Norby, F. L., Agarwal, S. K., Matsushita, K., Coresh, J., Alonso, Á., & Chen, L. Y. (2018) · Journal of the American Heart Association · doi:10.1161/jaha.117.007452 · Cited by 25
Comparison of Cardiovascular Risk Factors in European Population Cohorts for Predicting Atrial Fibrillation and Heart Failure, Their Subsequent Onset, and Death
Schrage, B., Geelhoed, B., Niiranen, T., Gianfagna, F., Vishram‐Nielsen, J. K. K., Costanzo, S., Söderberg, S., Ojeda, F., Vartiainen, E. A., Donati, M. B., et al. (2020) · Journal of the American Heart Association · doi:10.1161/jaha.119.015218 · Cited by 25
“3 The subsequent disease onset may be an indicator of disease deterioration.”
EARLY: a pilot study on early diagnosis of atrial fibrillation in a primary healthcare centre
Benito, L., Coll‐Vinent, B., Gomez, E., Marti, D., Mitjavila, J., Torres, F., Miró, Ò., Sisó‐Almirall, A., & Mont, L. (2015) · EP Europace · doi:10.1093/europace/euv146 · Cited by 25
Risk-Benefit Profile of Warfarin Versus Aspirin in Patients With Heart Failure and Sinus Rhythm: A Meta-analysis
Lee, M., Saver, J., Hong, K., Wu, H.-C., & Ovbiagele, B. (2013) · Circulation: Heart Failure · doi:10.1161/circheartfailure.112.971697 · Cited by 21
An Argument for Maintenance of Sinus Rhythm in Patients With Atrial Fibrillation
ZIMETBAUM, P. J. (2005) · Circulation · doi:10.1161/circulationaha.104.537175 · Cited by 24
Unsupervised deep learning of electrocardiograms enables scalable human disease profiling
Friedman, S. F., Khurshid, S. S., Venn, R. A., Wang, X., Diamant, N., Achille, P. D., Weng, L.-C. C., Choi, S. H., Reeder, C., Pirruccello, J. P., et al. (2025) · npj Digital Medicine · doi:10.1038/s41746-024-01418-9 · Cited by 30
Atrial fibrillation in heart failure: stroke risk stratification and anticoagulation
Abraham, J. M., & Connolly, S. J. (2014) · Heart Failure Reviews · doi:10.1007/s10741-014-9420-4 · Cited by 24
“Indeed, of those with a diagnosis of atrial fibrillation, about 40 % will develop a concomitant diagnosis of heart failure and the reverse is true as well [1, 2].”
Background
Cardiac arrhythmia and heart failure: From bench to bedside
Yong-Fu, X. (2011) · 老年心脏病学杂志：英文版 · doi:10.3724/sp.j.1263.2011.00131 · Cited by 24
Meta‐analysis of randomized controlled trials on atrial fibrillation ablation in patients with heart failure with reduced ejection fraction
Smer, A. M., Salih, M., Darrat, Y., Saadi, A., Guddeti, R. R., Haddad, T. M., Kabach, A., Ayan, M., Saurav, A., Abuissa, H. S., et al. (2018) · Clinical Cardiology · doi:10.1002/clc.23068 · Cited by 24
“The presence of AF and HF is associated with increased morbidity, mortality, and healthcare costs.(2,3) Restoration and maintenance”
Background
Are Atrial High-Rate Episodes Associated With Increased Risk of Ventricular Arrhythmias and Mortality?
Vergara, P., Solimene, F., D’Onofrio, A., Pisanò, E., Zanotto, G., Pignalberi, C., Iacopino, S., Maglia, G., Bella, P. E. D., Calvi, V. I., et al. (2019) · JACC. Clinical electrophysiology · doi:10.1016/j.jacep.2019.06.018 · Cited by 24
New‐onset atrial fibrillation in critically ill patients with coronavirus disease 2019 (COVID‐19)
Ergün, B., Ergan, B., Sözmen, M. K., Küçük, M., Yakar, M. N., Cömert, B., Gökmen, A. N., & Yaka, E. (2021) · Journal of Arrhythmia · doi:10.1002/joa3.12619 · Cited by 24
Automatic Detection of Short-Term Atrial Fibrillation Segments Based on Frequency Slice Wavelet Transform and Machine Learning Techniques
Yue, Y., Chen, C., Liu, P., Xing, Y., & Zhou, X. (2021) · Sensors · doi:10.3390/s21165302 · Cited by 24
“AF has strong associations with other CVDs, such as myocardial infarction (MI) and chronic heart failure (CHF) [6].”
Background
Role of sacubitril-valsartan in the prevention of atrial fibrillation occurrence in patients with heart failure: A systematic review and meta-analysis of randomized controlled trials
Liu, X., Liu, H., Wang, L., Zhang, L., & Xu, Q. (2022) · PLoS ONE · doi:10.1371/journal.pone.0263131 · Cited by 26
Biomarkers and heart failure events in patients with atrial fibrillation in the ARISTOTLE trial evaluated by a multi-state model
Aulin, J., Hijazi, Z., Lindbäck, J., Alexander, J. H., Gersh, B. J., Granger, C. B., Hanna, M., Horowitz, J. D., Lópes, R. D., McMurray, J. J. V., et al. (2022) · American Heart Journal · doi:10.1016/j.ahj.2022.03.009 · Cited by 24
The relationship between atrial fibrillation and NLRP3 inflammasome: a gut microbiota perspective
Xing, Y., Yan, L., Li, X., Xu, Z., Wu, X., Gao, H., Chen, Y., Ma, X., Liu, J., & Zhang, J. (2023) · Frontiers in Immunology · doi:10.3389/fimmu.2023.1273524 · Cited by 29
Prospective European Survey on Atrial Fibrillation Ablation: Clinical Characteristics of Patients and Ablation Strategies Used in Different Countries
Themistoclakis, S., Raviele, A., China, P., Pappone, C., Ponti, R. D., Revishvili, A. S., Aliot, E., Kück, K., Hoff, P. I., Shah, D. C., et al. (2014) · Journal of Cardiovascular Electrophysiology · doi:10.1111/jce.12462 · Cited by 24
Prognosis in Patients Hospitalized With Permanent and Nonpermanent Atrial Fibrillation in Heart Failure
Taillandier, S., Bernard, A. B., Lallemand, B., Siméon, E., Pericart, L., Clémenty, N., Babuty, D., & Fauchier, L. (2014) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2013.12.024 · Cited by 24
Atrial Fibrillation and Cardiovascular Outcomes in the Elderly
O’Neal, W. T., Salahuddin, T., Broughton, S. T., & Soliman, E. Z. (2016) · Pacing and Clinical Electrophysiology · doi:10.1111/pace.12907 · Cited by 24

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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