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Research Article| Volume 252, P117-121, February 01, 2018

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The interplay between atrial fibrillation and heart failure on long-term mortality and length of stay: Insights from the, United Kingdom ACALM registry

  • Author Footnotes
    1 All authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Oliver J. Ziff
    Footnotes
    1 All authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Affiliations
    Institute of Cardiovascular Science, University College London, London, UK

    Royal Free London NHS Foundation Trust, London, UK
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  • Author Footnotes
    1 All authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Paul R. Carter
    Footnotes
    1 All authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Affiliations
    Institute of Cardiovascular Science, University College London, London, UK

    Royal Free London NHS Foundation Trust, London, UK

    ACALM Study Unit in collaboration with Aston Medical School, Aston University, Birmingham, UK
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  • Author Footnotes
    1 All authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    John McGowan
    Footnotes
    1 All authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Affiliations
    Institute of Cardiovascular Science, University College London, London, UK
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  • Author Footnotes
    1 All authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Hardeep Uppal
    Footnotes
    1 All authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Affiliations
    ACALM Study Unit in collaboration with Aston Medical School, Aston University, Birmingham, UK
    Search for articles by this author
  • Author Footnotes
    1 All authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Suresh Chandran
    Footnotes
    1 All authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Affiliations
    ACALM Study Unit in collaboration with Aston Medical School, Aston University, Birmingham, UK
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  • Author Footnotes
    1 All authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Stuart Russell
    Footnotes
    1 All authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Affiliations
    East Cheshire NHS Trust, Macclesfield, UK
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  • Author Footnotes
    1 All authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Kevin R. Bainey
    Footnotes
    1 All authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Affiliations
    Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada
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  • Author Footnotes
    1 All authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Rahul Potluri
    Correspondence
    Corresponding author.
    Footnotes
    1 All authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Affiliations
    ACALM Study Unit in collaboration with Aston Medical School, Aston University, Birmingham, UK

    Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada
    Search for articles by this author
  • Author Footnotes
    1 All authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
DOI:https://doi.org/10.1016/j.ijcard.2017.06.033
The interplay between atrial fibrillation and heart failure on long-term mortality and length of stay: Insights from the, United Kingdom ACALM registry
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      Abstract

      Background

      There is concern that the development of heart failure and atrial fibrillation has a detrimental influence on clinical outcomes. The aim of this study was to assess all-cause mortality and length of hospital stay in patients with chronic and new-onset concomitant AF and HF.

      Methods

      Using the ACALM registry, we analysed adults hospitalised between 2000 and 2013 with AF and HF and assessed prevalence, mortality and length of hospital stay. Patients with HF and/or AF at baseline (study-entry) were compared with patients who developed new-onset disease during follow-up.

      Results

      Of 929,552 patients, 31,695 (3.4%) were in AF without HF, 20,768 (2.2%) had HF in sinus rhythm, and 10,992 (1.2%) had HF in AF. Patients with HF in AF had the greatest all-cause mortality (70.8%), followed by HF in sinus rhythm (64.1%) and AF alone (45.1%, p < 0.0001). Patients that developed new-onset AF, HF or both had significantly worse mortality (58.5%, 70.7% and 74.8% respectively) compared to those already with the condition at baseline (48.5%, 63.7% and 67.2% respectively, p < 0.0001). Patients with HF in AF had the longest length of hospital stay (9.41 days, 95% CI 8.90–9.92), followed by HF in sinus rhythm (7.67, 95% CI 7.34–8.00) and AF alone (6.05, 95% CI 5.78–6.31).

      Conclusions

      Patients with HF in AF are at a greater risk of mortality and longer hospital stay compared to patients without the combination. New-onset AF or HF is associated with significantly worse prognosis than long-standing disease.

      Keywords

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      Article info

      Publication history

      Accepted: June 5, 2017
      Received in revised form: April 9, 2017
      Received: November 10, 2016

      Identification

      DOI: https://doi.org/10.1016/j.ijcard.2017.06.033

      Copyright

      © 2017 Elsevier B.V. All rights reserved.

      ScienceDirect

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      Linked Article

      • Heart failure and atrial fibrillation: Can we break this nexus?
        International Journal of CardiologyVol. 252
        • Preview
          Heart failure (HF) [1] and atrial fibrillation (AF) [2] are ongoing epidemics, each making a major impact on morbidity, mortality and health care costs. Based on significant commonality of risk factors and pathophysiology, it is inevitable for these conditions to overlap. In the current issue of the Journal, Ziff and colleagues [3] present results from a large hospital-based database in the UK (ACALM registry), showing that patients who suffer from both HF and AF have significantly higher all-cause mortality over time (71%), compared to those with either HF (64%) or AF (45%).
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