Abstract：
OBJECTIVE: Atrial fibrillation (AF) is linked to heart failure (HF). However, little has been published on the factors that may precipitate the onset of HF in AF patients. We aimed to determine the incidence, predictors, and prognosis of incident HF in older patients with AF with no prior history of HF.
METHODS: Patients with AF older than 80 years and without prior HF were identified between 2014 and 2018.
RESULTS: A total of 5794 patients (mean age, 85.2±3.8 years; 63.2% women) were followed up for 3.7 years. Incident HF, predominantly with preserved left ventricular ejection fraction, developed in 33.3% (incidence rate, 11.5-100 people-year). Multivariate analysis identified 11 clinical risk factors for incident HF, irrespective of HF subtype: significant valvular heart disease (HR, 1.99; 95%CI, 1.73-2.28), reduced baseline left ventricular ejection fraction (HR, 1.92; 95%CI, 1.68-2.19), chronic pulmonary obstructive disease (HR, 1.59; 95%CI, 1.40-1.82), enlarged left atrium (HR 1.47, 95%CI 1.33-1.62), renal dysfunction (HR 1.36, 95%CI 1.24-1.49), malnutrition (HR, 1.33; 95%CI, 1.21-1.46), anemia (HR, 1.30; 95%CI, 1.17-1.44), permanent AF (HR, 1.15; 95%CI, 1.03-1.28), diabetes mellitus (HR, 1.13; 95%CI, 1.01-1.27), age per year (HR, 1.04; 95%CI, 1.02-1.05), and high body mass index for each kg/m2 (HR, 1.03; 95%CI, 1.02-1.04). The presence of incident HF nearly doubled the mortality risk (HR, 1.67; 95%CI, 1.53-1.81).
CONCLUSIONS: The presence of HF in this cohort was relatively frequent and nearly doubled the mortality risk. Eleven risk factors for HF were identified, expanding the scope for primary prevention among elderly patients with AF.
METHODS: Patients with AF older than 80 years and without prior HF were identified between 2014 and 2018.
RESULTS: A total of 5794 patients (mean age, 85.2±3.8 years; 63.2% women) were followed up for 3.7 years. Incident HF, predominantly with preserved left ventricular ejection fraction, developed in 33.3% (incidence rate, 11.5-100 people-year). Multivariate analysis identified 11 clinical risk factors for incident HF, irrespective of HF subtype: significant valvular heart disease (HR, 1.99; 95%CI, 1.73-2.28), reduced baseline left ventricular ejection fraction (HR, 1.92; 95%CI, 1.68-2.19), chronic pulmonary obstructive disease (HR, 1.59; 95%CI, 1.40-1.82), enlarged left atrium (HR 1.47, 95%CI 1.33-1.62), renal dysfunction (HR 1.36, 95%CI 1.24-1.49), malnutrition (HR, 1.33; 95%CI, 1.21-1.46), anemia (HR, 1.30; 95%CI, 1.17-1.44), permanent AF (HR, 1.15; 95%CI, 1.03-1.28), diabetes mellitus (HR, 1.13; 95%CI, 1.01-1.27), age per year (HR, 1.04; 95%CI, 1.02-1.05), and high body mass index for each kg/m2 (HR, 1.03; 95%CI, 1.02-1.04). The presence of incident HF nearly doubled the mortality risk (HR, 1.67; 95%CI, 1.53-1.81).
CONCLUSIONS: The presence of HF in this cohort was relatively frequent and nearly doubled the mortality risk. Eleven risk factors for HF were identified, expanding the scope for primary prevention among elderly patients with AF.
摘要：
目的：心房颤动（AF）与心力衰竭（HF）有关。然而,关于可能导致AF患者发生HF的因素的报道很少.我们的目的是确定发病率，预测因子,无HF病史的老年房颤患者发生HF的预后。
方法：在2014年至2018年之间确定了80岁以上无HF的房颤患者。
结果：总共5794名患者（平均年龄，85.2±3.8年；63.2％的女性）随访3.7年。突发HF,主要保留左心室射血分数，发展为33.3%(发病率，11.5-100人年）。多变量分析确定了11例HF事件的临床危险因素，无论HF亚型如何：显著的瓣膜性心脏病(HR，1.99；95CI，1.73-2.28），基线左心室射血分数降低(HR，1.92；95CI，1.68-2.19），慢性阻塞性肺疾病（HR，1.59；95CI，1.40-1.82），左心房增大（HR1.47，95CI1.33-1.62），肾功能不全（HR1.36，95CI1.24-1.49），营养不良(HR，1.33；95CI，1.21-1.46)，贫血（HR，1.30；95CI，1.17-1.44)，永久性AF（HR，1.15；95CI，1.03-1.28)，糖尿病（HR，1.13；95CI，1.01-1.27)，年龄每年（HR，1.04；95CI，1.02-1.05)，和每kg/m2的高体重指数(HR，1.03；95CI，1.02-1.04）。HF事件的存在几乎使死亡风险增加了一倍(HR，1.67；95CI，1.53-1.81）。
结论：该队列中HF的存在相对频繁，并且死亡风险几乎增加了一倍。确定了11个HF的危险因素，扩大老年房颤患者一级预防范围。
方法：在2014年至2018年之间确定了80岁以上无HF的房颤患者。
结果：总共5794名患者（平均年龄，85.2±3.8年；63.2％的女性）随访3.7年。突发HF,主要保留左心室射血分数，发展为33.3%(发病率，11.5-100人年）。多变量分析确定了11例HF事件的临床危险因素，无论HF亚型如何：显著的瓣膜性心脏病(HR，1.99；95CI，1.73-2.28），基线左心室射血分数降低(HR，1.92；95CI，1.68-2.19），慢性阻塞性肺疾病（HR，1.59；95CI，1.40-1.82），左心房增大（HR1.47，95CI1.33-1.62），肾功能不全（HR1.36，95CI1.24-1.49），营养不良(HR，1.33；95CI，1.21-1.46)，贫血（HR，1.30；95CI，1.17-1.44)，永久性AF（HR，1.15；95CI，1.03-1.28)，糖尿病（HR，1.13；95CI，1.01-1.27)，年龄每年（HR，1.04；95CI，1.02-1.05)，和每kg/m2的高体重指数(HR，1.03；95CI，1.02-1.04）。HF事件的存在几乎使死亡风险增加了一倍(HR，1.67；95CI，1.53-1.81）。
结论：该队列中HF的存在相对频繁，并且死亡风险几乎增加了一倍。确定了11个HF的危险因素，扩大老年房颤患者一级预防范围。
