The optimal management of patient with permanent atrial fibrillation and heart failure with reduced ejection fraction – The permanent His-bundle pacing is a solution. A case report

Heart failure (HF) and atrial fibrillation (AF) are the most common cardiovascular conditions in clinical practice and frequently coexist. The number of patients with HF and AF is increasing every year.Aim. To analyze the effect of clinical course and management of HF and AF on the outcomes.Material and methods. The data of 1,003 patients from the first Russian register of patients with HF and AF (RIF-CHF) were analyzed. The endpoints included hospitalization due to decompensated HF, cardiovascular mortality, thromboembolic events, and major bleeding. Predictors of unfavorable outcomes were analyzed separately for patients with HF with preserved ejection fraction (AF+HFpEF), mid-range ejection fraction (AF+HFmrEF), and reduced ejection fraction (AF+HFrEF).Results. Among all patients with HF, 39% had HFpEF, 15% — HFmrEF, and 46% — HFrEF. A total of 57,2% of patients were rehospitalized due to decompensated HF within one year. Hospitalization risk was the highest for HFmrEF patients (66%, p=0,017). Reduced ejection fraction was associated with the increased risk of cardiovascular mortality (15,5% vs 5,4% in other groups, p<0,001) but not ischemic stroke (2,4% vs 3%, p=0,776). Patients with HFpEF had lower risk to achieve the composite endpoint (stroke+MI+cardiovascular death) as compared to patients with HFmrEF and HFrEF (12,7% vs 22% and 25,5%, p<0,001). Regression logistic analysis revealed that factors such as demographic characteristics, disease severity, and selected therapy had different effects on the risk of unfavorable outcomes depending on ejection fraction group.Conclusion. Each group of patients with different ejection fractions is characterized by its own pattern of factors associated with unfavorable outcomes. The demographic and clinical characteristics of patients with mid-range ejection fraction demonstrate that these patients need to be studied as a separate cohort.

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Predictors for early mortality in patients with implantable cardiac defibrillator for heart failure with reduced ejection fraction

EP Europace ◽

10.1093/europace/euab116.422 ◽

2021 ◽

Vol 23 (Supplement_3) ◽

Author(s):

G Cinier ◽

MI Hayiroglu ◽

L Pay ◽

AC Yumurtas ◽

O Tezen ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Multivariate Analysis ◽

Ejection Fraction ◽

Blood Urea Nitrogen ◽

Cox Regression ◽

Nyha Class ◽

Urea Nitrogen ◽

Reduced Ejection Fraction ◽

Device Implantation

Abstract Funding Acknowledgements Type of funding sources: None. Background Implantable cardiac defibrillators (ICD) are recommended in heart failure with reduced ejection fraction (HFrEF) patients to reduce arrhythmic deaths. The only contraindication for not implanting ICD is life expectancy of less than 1 year. We aimed to identify risk factors associated with mortality within 1 year following the device implantation. Methods Data from our hospital’s electronic database system was extracted for patients who were implanted ICD secondary to HFrEF between 2009 and 2019. Those who died within 1 year following the device implantation were analyzed in the present paper. Multiple Cox regression analysis using the backward logistical regression method was applied to determine the best predictors that affect 1-year mortality Results Overall 1107 patients were included in the present analysis. ICD was implanted in 77.2% and 22.8% for ischemic and non-ischemic HFrEF respectively. Mortality rate at 1-year following the device implantation was 4.7%. In multivariate analysis age [Hazard ratio (HR), 1.04; Confidence 95% Intervals (CI), 1.02 – 1.06; P = 0.001], atrial fibrillation (AF) (HR, 4.12; 95% CI, 2.34 – 7.24, P < 0.001), NYHA class > 2 symptoms (HR, 5.33; 95% CI, 2.92 – 9.73, P < 0.001), blood urea nitrogen (BUN) (HR, 1.02; 95% CI, 1.00 – 1.03, P = 0.03) and albumin (HR, 0.52; 95% CI, 0.34 – 0.80, P = 0.003) independently predicted 1-year mortality Conclusion In patients with HFrEF and implanted ICD, older age, presence of AF and NYHA class > II symptoms, elevated BUN and reduced albumin levels predicted 1-year mortality. Table 1 Multivariate analysis P value HR (95% CI) Age 0.001 1.038 (1.015 - 1.062) Atrial fibrillation <0.001 4.119 (2.342 - 7.241) NYHA > 2 <0.001 5.328 (2.917 - 9.731) Blood urea nitrogen 0.034 1.017 (1.001- 1.034) Albumin 0.003 0.520 (0.337 - 0.801) Multivariate Cox regression analyses for 1-year mortality after implantation

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Biomarkers in atrial fibrillation and heart failure with non-reduced ejection fraction: Diagnostic application and new cut-off points

Heart & Lung ◽

10.1016/j.hrtlng.2020.02.043 ◽

2020 ◽

Vol 49 (4) ◽

pp. 388-392

Author(s):

Ana Merino-Merino ◽

Ruth Saez-Maleta ◽

Ricardo Salgado-Aranda ◽

Daniel AlKassam-Martinez ◽

Virginia Pascual-Tejerina ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Ejection Fraction ◽

Reduced Ejection Fraction ◽

Diagnostic Application

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Frequency, predictors, and prognosis of ejection fraction improvement in heart failure: an echocardiogram-based registry study

European Heart Journal ◽

10.1093/eurheartj/ehz233 ◽

2019 ◽

Vol 40 (26) ◽

pp. 2110-2117 ◽

Cited By ~ 18

Author(s):

Anukul Ghimire ◽

Nowell Fine ◽

Justin A Ezekowitz ◽

Jonathan Howlett ◽

Erik Youngson ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Ejection Fraction ◽

Mortality Risk ◽

Left Ventricular ◽

Lower Mortality ◽

Ventricular Assist ◽

Reduced Ejection Fraction ◽

Multivariable Adjustment ◽

Lower Mortality Risk

Abstract Aims To identify variables predicting ejection fraction (EF) recovery and characterize prognosis of heart failure (HF) patients with EF recovery (HFrecEF). Methods and results Retrospective study of adults referred for ≥2 echocardiograms separated by ≥6 months between 2008 and 2016 at the two largest echocardiography centres in Alberta who also had physician-assigned diagnosis of HF. Of 10 641 patients, 3124 had heart failure reduced ejection fraction (HFrEF) (EF ≤ 40%) at baseline: while mean EF declined from 30.2% on initial echocardiogram to 28.6% on the second echocardiogram in those patients with persistent HFrEF (defined by <10% improvement in EF), it improved from 26.1% to 46.4% in the 1174 patients (37.6%) with HFrecEF (defined by EF absolute improvement ≥10%). On multivariate analysis, female sex [adjusted odds ratio (aOR) 1.66, 95% confidence interval (CI) 1.40–1.96], younger age (aOR per decade 1.16, 95% CI 1.09–1.23), atrial fibrillation (aOR 2.00, 95% CI 1.68–2.38), cancer (aOR 1.52, 95% CI 1.03–2.26), hypertension (aOR 1.38, 95% CI 1.18–1.62), lower baseline ejection fraction (aOR per 1% decrease 1.07 (1.06–1.08), and using hydralazine (aOR 1.69, 95% CI 1.19–2.40) were associated with EF improvements ≥10%. HFrecEF patients demonstrated lower rates per 1000 patient years of mortality (106 vs. 164, adjusted hazard ratio, aHR 0.70 [0.62–0.79]), all-cause hospitalizations (300 vs. 428, aHR 0.87 [0.79–0.95]), all-cause emergency room (ER) visits (569 vs. 799, aHR 0.88 [0.81–0.95]), and cardiac transplantation or left ventricular assist device implantation (2 vs. 10, aHR 0.21 [0.10–0.45]) compared to patients with persistent HFrEF. Females with HFrEF exhibited lower mortality risk (aHR 0.94 [0.88–0.99]) than males after adjusting for age, time between echocardiograms, clinical comorbidities, medications, and whether their EF improved or not during follow-up. Conclusion HFrecEF patients tended to be younger, female, and were more likely to have hypertension, atrial fibrillation, or cancer. HFrecEF patients have a substantially better prognosis compared to those with persistent HFrEF, even after multivariable adjustment, and female patients exhibit lower mortality risk than men within each subgroup (HFrecEF and persistent HFrEF) even after multivariable adjustment.

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