Atrial fibrillation in patients hospitalized for congestive heart failure: The same prognostic influence independently of left ventricular systolic function?

Atrial fibrillation (AF) was described to be associated with an adverse prognosis in several studies of heart failure (HF). However, it is not clear whether it directly increased mortality or is only a marker for severity of HF. Aims To determine the influence of AF on mortality of HF patients distinguishing between patients with preserved and deteriorated systolic function (SF). Method and results 1636 patients who, between 1991 and 2002 had been hospitalized in a Cardiology Service for HF, were studied. Survival (SV) data (mean follow-up time: 3.14 years) has shown that there was no difference in SV between patients with (540 patients of the whole group) and without AF in the group with preserved SF (presented in 38.7% of cases), however, in the group of patients with deteriorated SF (AF presented in 31.0% of cases), SV time was significantly (p = 0.01) shorter among patients with AF, this association being independent of age, sex, aetiology, risk factors, clinical signs and pharmacological treatment; relative risk: 1.831(1.120–2.994). Conclusion AF is more prevalent among HF patients with preserved SF than among those with deteriorated SF, but only increases the risk of death among the latter.