Progression of Heart Failure Is Associated with Higher Mortality in Patients with Atrial Fibrillation: The Fushimi AF Registry

Purpose: Heart failure (HF) is a leading cause of death among patients with atrial fibrillation (AF). We investigated the relationship between progression of HF and mortality in Japanese AF patients from the Fushimi AF Registry. Methods and Results: The Fushimi AF Registry, a community-based prospective survey, was designed to enroll all of the AF patients who visited the participating medical institutions in Fushimi-ku, Kyoto, Japan. Follow-up data were available in 4,066 patients (median follow-up period, 1,103 days). 1,111 patients had HF (either of prior hospitalization for HF, symptomatic HF, or reduced ejection fraction (<40%)) at baseline, and 254 (22.9%) of patient with HF and 175 (5.9%) of patients without HF were hospitalized for HF during the follow-up periods. After hospitalization for HF, both cardiovascular (hazard ration (HR), 8.63; 95% confidence interval (CI), 5.84–12.7) and non-cardiovascular mortality (HR, 2.29; 95%CI, 1.80–2.88) were markedly increased in both groups. Low body mass index (HR, 1.10; 95%CI, 1.01–1.20) was associated with cardiovascular death after hospitalization for HF, while higher age (HR, 1.08; 95%CI, 1.04–1.11), reduced ejection fraction (HR, 2.12; 95%CI, 1.15–3.80), and chronic obstructive pulmonary disease (HR, 2.39; 95%CI, 1.21–4.37) were associated with non-cardiovascular death. Conclusion: Progression of HF was associated with higher mortality in Japanese AF patients.