History of prior heart failure (HF) was found to influence prognostic implications of atrial fibrillation (AFib) in patients hospitalized for HF, with permutations of prior HF, prior AFib and AFib as presenting rhythm differentiating outcome, according to a study published Feb. 5 in JACC: Heart Failure.

Janice Yu-Hsin Chyou, MD, FACC, et al., included 13,401 patients (median age 67 years, 61% men, 58% prior HF) from REPORT-HF, a global registry spanning 44 countries across six continents. The authors examined one-year all-cause mortality according to permutations of prior HF, prior AFib and AFib as presenting rhythm using Cox proportional hazard models.

Results showed that when compared to patients with no prior HF, no prior AFib and presenting in sinus rhythm, one-year all-cause mortality was higher in patients with prior HF, prior AFib and presenting in AFib (adjusted hazard ratio [HR], 1.54; 95% CI, 1.34-1.78; p<0.001) as well as in patients with prior HF, no prior AFib and presenting in AFib (adjusted HR, 1.51, CI,1.20-1.90, p<0.001).

Patients with no prior HF and with prior AFib or presenting in AFib did not have elevated mortality when compared to the patient group with no prior HF, no prior AFib and presenting in sinus rhythm. These findings were consistent across subgroups broken down by LVEF and race.

The authors highlight how their "novel combinatorial analyses clarifies the importance of prior HF," stating: "Our permutational approach tackled the complex interplay of [AFib] and HF in association with clinical outcomes, yielding specific clinically relevant observations that advance our understanding of prognostic implications of [AFib] in patients with HF."