Journal
HEART RHYTHM
Volume 18, Issue 5, Pages 709-716Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.hrthm.2021.01.021
Keywords
Arrhythmia burden; Atrial fibrillation; Heart failure; Medicare; Outcomes; Remote monitoring
Categories
Funding
- Abbott
- National Heart, Lung, and Blood Institute of the National Institutes of Health [K23HL143156]
- National Heart, Lung, and Blood Institute [R01HL128595]
- American Heart Association
- Association for the Advancement of Medical Instrumentation
- Bayer
- Boston Scientific
- Philips
Ask authors/readers for more resources
In older patients with AF receiving a CIED, increasing AF burden is significantly associated with increasing risk of adverse HF outcomes and all-cause mortality.
BACKGROUND Atrial fibrillation (AF) and heart failure (HF) often accompany one another, and each is independently associated with poor outcomes. However, the association between AF burden and outcomes is poorly understood. OBJECTIVE The purpose of this study was to describe the association between device-based AF burden and HF clinical outcomes. METHODS We used a nationwide, remote monitoring database of cardiac implantable electronic devices (CIEDs) linked to Medicare claims. We included patients with nonpermanent AF, undergoing new CIED implant, stratified by baseline HF. The outcomes were new-onset HF, HF hospitalization, and all-cause mortality at 1 and 3 years. RESULTS We identified 39,710 patients who met inclusion criteria (25,054 with HF; 14,656 without HF). Patients with HF were younger (mean age 76.3 vs 78.5 years; P <.001), more often male (65% vs 54%; P <.001), and had higher mean CHA(2)DS(2) VASc scores (5.4 vs 4.1; P <.001). Among those without HF, increasing device-based AF burden was significantly associated with increased risk of new-onset HF (adjusted hazard ratio [HR] 1.09 per 10% AF burden; 95% confidence interval [CI] 1.06-1.12; P <.001) and ad-cause mortality (adjusted HR 1.05 per 10% AF burden; 95% CI 1.01-1.10; P = .012). Among patients with HF, increasing AF burden was significantly associated with increased risk of HF hospitalization (adjusted HR 1.05 per 10% AF burden; 95% CI 1.04-1.06; P <.001) and all-cause mortality (adjusted HR 1.06 per 10% AF burden; 95% CI 1.05-1.08; P <.001). CONCLUSION Among older patients with AF receiving a CIED, increasing AF burden is significantly associated with increasing risk of adverse HF outcomes and all-cause mortality.
Authors
I am an author on this paper
Click your name to claim this paper and add it to your profile.
Reviews
Recommended
No Data Available