{"doi":"10.1016/j.hroo.2022.04.008","title":"Prognostic importance of atrial fibrillation in heart failure according to time elapsed since diagnosis","abstract":"Key Findings▪Although mortality risk seems to decline over time in heart failure (HF) patients with and without concomitant atrial fibrillation (AF), the presence of AF significantly reduces the rate at which this risk declines.▪The prognostic implications of our findings on concomitant AF and HF may impact management decisions (eg, rate vs rhythm control) for patients with these 2 comorbid conditions. ▪Although mortality risk seems to decline over time in heart failure (HF) patients with and without concomitant atrial fibrillation (AF), the presence of AF significantly reduces the rate at which this risk declines.▪The prognostic implications of our findings on concomitant AF and HF may impact management decisions (eg, rate vs rhythm control) for patients with these 2 comorbid conditions. Atrial fibrillation (AF) is a common comorbidity in patients with heart failure (HF) that may compromise cardiac contractility and exacerbate the HF syndrome.1Lee Park K. Anter E. Atrial fibrillation and heart failure: a review of the intersection of two cardiac epidemics.J Atr Fibrillation. 2013; 6: 751PubMed Google Scholar Multiple studies point to increased mortality in HF complicated by AF (compared to HF with sinus rhythm), regardless of the time of AF onset in relation to HF syndrome.2Barillas-Lara M.I. Monahan K. Helm R.H. et al.Sex-specific prevalence, incidence, and mortality associated with atrial fibrillation in heart failure.JACC Clin Electrophysiol. 2021; 7: 1366-1375Crossref PubMed Scopus (5) Google Scholar Mortality rates for HF patients generally are greatest early after onset and tend to decrease with time elapsed since the diagnosis; however, whether the presence of AF alters such a clinical course is unknown. Given the uncertainty regarding optimal management strategies for patients with both diagnoses, it would be important to examine the mortality risks of HF patients with and without AF based on timing and duration of both conditions.3Smit M.D. Moes M.L. Maass A.H. et al.The importance of whether atrial fibrillation or heart failure develops first.Eur J Heart Fail. 2012; 14: 1030-1040Crossref PubMed Scopus (63) Google Scholar This study was exempt from ethical board approval. The Declaration of Helsinki was not relevant given its registry-based setup in which individuals could not be identified; consent was waived for the same reason. Through the Danish nationwide administrative registries, we followed all patients with a first diagnosis of HF (any diagnosis, regardless of left ventricular ejection fraction, both inpatient and outpatient, ICD-8 codes 427.09–427.11, 427.19, 424.49, ICD-10 codes I42, I43, and I50) for all-cause mortality over the years 1998–2018. Mean follow-up was 6.2 ± 5.8 years. Details of the study population have been previously reported.2Barillas-Lara M.I. Monahan K. Helm R.H. et al.Sex-specific prevalence, incidence, and mortality associated with atrial fibrillation in heart failure.JACC Clin Electrophysiol. 2021; 7: 1366-1375Crossref PubMed Scopus (5) Google Scholar We identified and grouped AF (ICD-8 codes 427.93–427.94, ICD-10 code I48) as occurring antecedent, concomitant with (diagnosed the same day), or after the HF diagnosis. Exposure groups were defined at the start of each year since HF onset for the landmark analysis.4Dafni U. Landmark analysis at the 25-year landmark point.Circ Cardiovasc Qual Outcomes. 2011; 4: 363-371Crossref PubMed Scopus (289) Google Scholar We used time-dependent Poisson regression models, adjusted for age, sex, calendar year, hypertension, diabetes, acute myocardial infarction, ischemic heart disease, dilated cardiomyopathy, aortic valve replacement, mitral valve repair or replacement, prior stroke, chronic obstructive pulmonary disease, cancer, renal disease, liver disease, anticoagulation therapy, angiotensin-converting enzyme inhibitor and angiotensin II receptor blockers, calcium channel blockers, beta-blockers, statin, aspirin, and the presence of a pacemaker a","journal":"Heart Rhythm O2","year":2022,"id":308487,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9615,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2022-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":57274,"name":"Morten Schou","orcid":"0000-0002-1274-5072","position":1,"is_corresponding":false},{"id":1003360,"name":"Irene Maria Barrillas Lara","orcid":null,"position":2,"is_corresponding":false},{"id":699816,"name":"Kevin M. Monahan","orcid":null,"position":3,"is_corresponding":false},{"id":640019,"name":"Robert Helm","orcid":"0000-0002-4562-6950","position":4,"is_corresponding":false},{"id":2621,"name":"Lars Køber","orcid":"0000-0002-6635-1466","position":5,"is_corresponding":false},{"id":58646,"name":"Gunnar Gislason","orcid":"0000-0002-0548-402X","position":6,"is_corresponding":false},{"id":24661,"name":"Ramachandran S. Vasan","orcid":"0000-0001-7357-5970","position":7,"is_corresponding":false},{"id":910403,"name":"Christian Torp‐Pedersen","orcid":"0000-0003-2892-6131","position":8,"is_corresponding":false},{"id":274759,"name":"Charlotte Andersson","orcid":"0000-0001-6019-8627","position":9,"is_corresponding":false},{"id":954871,"name":"Brian Schwartz","orcid":"0000-0001-5087-9293","position":0,"is_corresponding":true}],"reference_count":5,"raw_metadata":null,"created_at":"2026-07-19T00:33:03.486542Z","pmid":"36097453","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}