EHJ: A-fib leads to increased hospitalization, but not increased mortality

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Patients with atrial fibrillation (AF) have an increased risk of hospitalization due to heart failure, according to a propensity-matched study published in the June issue of the European Heart Journal, which also suggested that AF is not associated with an increased risk of death in heart failure patients, contradicting previous assumptions.

"Our findings show that the presence of atrial fibrillation in heart failure patients did not increase their risk of death, as has been previously suggested, but did increase the risk of hospitalization due to worsening heart failure," said the study's lead investigator Mustafa Ahmed, MD, a physician-scientist at the University of Alabama at Birmingham (UAB) American Board of Internal Medicine Research Pathway Program.

Ahmed and colleagues matched 487 pairs of heart failure patients with and without AF from the Beta-Blocker Evaluation of Survival Trial [BEST]. They found that all-cause mortality occurred in 38 percent of the patients with AF against 37 percent of patients without. However, 44 percent patients with AF were hospitalized for worsening heart failure over the course of the trial, against only 38 percent without.

The authors also noted that the hazard ratios and 95 percent confidence intervals for AF-associated heart failure hospitalization for bucindolol and placebo groups were, respectively, 1.08 and 1.54. The beta blocker bucindolol was being developed by Bristol Myers Squibb in 1999, until it did not achieve its primary endpoint in BEST.

"Importantly, atrial fibrillation significantly increased hospitalization due to heart failure only in patients not receiving a beta blocker or drugs that block the beta-receptors in the heart but not in those receiving a beta blocker," said the study's senior investigator Ali Ahmed, MD, associate professor in the division of gerontology, geriatrics and palliative care medicine and director of UAB's Geriatric Heart Failure Clinic. "In patients with heart failure and atrial fibrillation, beta blockers, which help reduce heart rate, may be useful in reducing the risk of hospitalization due to worsening heart failure."

The National Heart, Lung and Blood Institute, one of the National Institutes of Health, and a donation from Jean B. Morris of Birmingham, Ala., supported the research for this study.