Prevalence and Prognostic Implication of Atrial Fibrillation in Heart Failure Subtypes: Systematic Review and Meta-Analysis

Author(s)
Mundisugih, Juan
Franke, Kyle B
Tully, Phillip J
Munawar, Dian A
Kumar, Saurabh
Mahajan, Rajiv
Publication Date
2023-06
Abstract
<p><b>Background</b></p> <p>Atrial fibrillation (AF) and heart failure (HF) portends a poor outcome. The HF universal definition has incorporated Heart Failure with mildly reduced Ejection Fraction (HFmrEF). We sought to evaluate the relationship between AF and different HF subtypes, with emphasis on HFmrEF.</p> <p><b>Methods</b></p> <p>PubMed and Embase databases were searched up to July 2022. Studies that classified HF with EF≥50% as Heart Failure with Preserved Ejection Fraction (HFpEF); EF 40%–49% as HFmrEF; and EF <40% as Heart Failure with Reduced Ejection Fraction (HFrEF) were included.</p> <p><b>Results</b></p> <p>Fifty (50) eligible studies, with 126,720 acute HF and 109,683 chronic HF patients, were included. Ten percent (10%) and 12% of patients constituted HFmrEF subtype in patients with acute and chronic HF, respectively. The AF prevalence was 38% (95%CI [33, 44], I<sup>2</sup>=96.9%) in HFmrEF, as compared to 43% (95%CI [39, 47], I<sup>2</sup>=97.9%) in HFpEF, and 32% (95%CI [29, 35], I<sup>2</sup>=98.6%) in HFrEF in acute HF patients. Meta-regression showed HFmrEF shared age as a determinant for AF prevalence with HFrEF and HFpEF. Similar AF prevalence also was observed in chronic HF. Compared to sinus rhythm, AF was associated with an increased risk of all-cause mortality in all HF subtypes: HFmrEF (n=6; HR 1.28, 95%CI [1.08, 1.51], I<sup>2</sup>=71%), HFpEF (n=10; HR 1.14, 95%CI [1.06, 1.23], I<sup>2</sup>=55%) and HFrEF (n=9; HR 1.11, 95%CI [1.02, 1.21], I<sup>2</sup>=78%).</p> <p><b>Conclusion</b></p> The prevalence of AF was intermediate for HFmrEF in between HFpEF and HFrEF, with determinants shared with either HF subtype. The co-existence of AF and HF predicts an increased all-cause mortality across all categories of HF. (PROSPERO registry: CRD42021189411)
Citation
Heart, Lung and Circulation, 32(6), p. 666-677
ISSN
1444-2892
1443-9506
Link
Publisher
Elsevier Australia
Title
Prevalence and Prognostic Implication of Atrial Fibrillation in Heart Failure Subtypes: Systematic Review and Meta-Analysis
Type of document
Journal Article
Entity Type
Publication

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