Clinical InvestigationElectrophysiologyBurden of atrial fibrillation and poor rate control detected by continuous monitoring and the risk for heart failure hospitalization
Section snippets
Background
In the United States, >2.2 million people have atrial fibrillation (AF) and >5.7 million have heart failure (HF).1 In patients hospitalized with AF, the most common primary diagnosis is HF.1 In patients with HF, AF is the most common arrhythmia.2, 3, 4 The Euro Heart Surveys showed that HF is present in 34% of patients with AF3 and AF is present in 42% of patients with HF.4 In patients with AF or HF, subsequent development of the other condition was associated with increased mortality.2 Atrial
Data set and event definitions
The retrospective analysis included data available from the PARTNERS-HF15 (N = 699 patients), FAST16 (N = 146 patients), OFISSER17 (N = 323 patients), Case Study Registry (N = 80 patients), and CONNECT18 (N = 313 patients) studies. PARTNERS-HF was a prospective observational study enrolling patients with CRT-D devices with EF ≤35%, New York Heart Association (NYHA) class III or IV, and QRS duration ≥130 ms. FAST was a prospective double-blinded observational study in patients with CRT-D or ICD
Results
A total of 1,561 patients with an average follow-up duration of 373 ± 146 days were used for this analysis. A total of 326 HF hospitalizations were identified in 207 patients (13%) providing an event rate of 0.2 per patient-year of monitoring. The baseline characteristics of the patients in the study are shown in the Table. Patients in the AF cohort were older and more likely to be males compared with patients with “no-AF.” No significant differences were observed for ejection fraction, history
Discussion
The study presented a retrospective data analysis to evaluate the ability of continuous AF monitoring to predict future HF hospitalizations. One day with high burden (>6 hours) of paroxysmal AF with good rate control in last 30 days (AFb + NVR group) increases the risk for HF hospitalization in the next 30 days. The risk increases further if there is 1 day of poor rate control during persistent AF or high burden paroxysmal AF (AFb + RVR group). Thus, a high burden of paroxysmal AF (>6 hours)
Conclusion
The current study identifies thresholds for creating different AFb and rate control groups and shows that evaluation of AFb and rate control information on a monthly basis can identify patients at risk for HF hospitalization in the next 30 days. Future studies are needed to validate the chosen threshold for categorizing different risk groups in a broader HF patient population and to evaluate whether timely intervention based on AF diagnostics can reduce cardiovascular hospitalizations in
References (35)
- et al.
Atrial fibrillation and heart failure in cardiology practice: reciprocal impact and combined management from the perspective of atrial fibrillation: results of the Euro Heart Survey on atrial fibrillation
J Am Coll Cardiol
(2009) - et al.
Atrial fibrillation and risk of clinical events in chronic heart failure with and without left ventricular systolic dysfunction: results from the Candesartan in Heart failure-Assessment of Reduction in Mortality and morbidity (CHARM) program
J Am Coll Cardiol
(2006) - et al.
Atrial fibrillation is associated with an increased risk for mortality and heart failure progression in patients with asymptomatic and symptomatic left ventricular systolic dysfunction: a retrospective analysis of the SOLVD trials. Studies of Left Ventricular Dysfunction
J Am Coll Cardiol
(1998) - et al.
Comparison of continuous versus intermittent monitoring of atrial arrhythmias
Heart Rhythm
(2006) - et al.
Device-detected atrial tachyarrhythmias predict adverse outcome in real-world patients with implantable biventricular defibrillators
J Am Coll Cardiol
(2011) - et al.
Combined heart failure device diagnostics identify patients at higher risk of subsequent heart failure hospitalizations: results from PARTNERS HF (Program to Access and Review Trending Information and Evaluate Correlation to Symptoms in Patients With Heart Failure) study
J Am Coll Cardiol
(2010) - et al.
Changes in intrathoracic impedance are associated with subsequent risk of hospitalizations for acute decompensated heart failure: clinical utility of implanted device monitoring without a patient alert
J Card Fail
(2009) - et al.
CONNECT Investigators. The CONNECT (Clinical Evaluation of Remote Notification to Reduce Time to Clinical Decision) Trial The Value of Wireless Remote Monitoring With Automatic Clinician Alerts
J Am Coll Cardiol
(2011) - et al.
Quality of care for atrial fibrillation among patients hospitalized for heart failure
J Am Coll Cardiol
(2009) - et al.
Maintenance of sinus rhythm and survival in patients with heart failure and atrial fibrillation
J Am Coll Cardiol
(2010)
Comparison of beta blocker and digoxin alone and in combination for management of patients with atrial fibrillation and heart failure
Am J Cardiol
Efficacy and safety of dabigatran compared with warfarin at different levels of international normalised ratio control for stroke prevention in atrial fibrillation: an analysis of the RE-LY trial
Lancet
Randomized trial of a daily electronic home monitoring system in patients with advanced heart failure: the Weight Monitoring in Heart Failure (WHARF) trial
Am Heart J
Noninvasive home telemonitoring for patients with heart failure at high risk of recurrent admission and death: the Trans-European Network-Home-Care Management System (TEN-HMS) study
J Am Coll Cardiol
Randomized controlled trial of an implantable continuous hemodynamic monitor in patients with advanced heart failure: the COMPASS-HF study
J Am Coll Cardiol
Wireless pulmonary artery haemodynamic monitoring in chronic heart failure: a randomised controlled trial
Lancet
Heart Disease and Stroke Statistics—2011 update: a report from the American Heart Association
Circulation
Cited by (40)
Standardized Definitions for Evaluation of Heart Failure Therapies: Scientific Expert Panel From the Heart Failure Collaboratory and Academic Research Consortium
2020, JACC: Heart FailureCitation Excerpt :This author group believes that multiple attributes of AF may be appropriate endpoints for use in a HF clinical trial, specifically both the presence of new or recurrent AF and the daily time burden of AF (63). AF lasting more than 6 h in a 24 h period identifies patients at greater risk of HF outcomes (64). Atrial fibrillation burden: Cumulative time spent in AF over a specified time period documented by a validated rhythm monitoring method.