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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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“(4) The clinical outcomes of RFCA were not significantly different between SHD/SND and lone AF for 14.”
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“Atrial fibrillation (AF) is the most common sustained arrhythmia and is associated with considerable morbidity and mortality [21].”
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“Atrial fibrillation and heart failure have common risk factors and frequently coexist.(4) When occurring simultaneously, these conditions contribute to each other’s physiologic development and maintenance, which leads to a worse prognosis than with either condition alone.”
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“heart failure compared with RECORD (26%) and other studies, [20,21].”
ResultLaurent, G., Moe, G. W. P. L., Hu, X., So, P. P., Ramadeen, A., Leong-Poi, H. M., Doumanovskaia, L., König, A. A., Trogadis, J. E., Courtman, D. W., et al. (2008) · Journal of Cardiac Failure · doi:10.1016/j.cardfail.2007.10.021 · Cited by 19
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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