A new study conducted by researchers at Intermountain Health in Salt Lake City has revealed a high number of patients diagnosed with heart failure who also have atrial fibrillation (AF), a co-occurrence that leads to significantly worse health outcomes. The study’s findings suggest that regular screening for AF in patients with newly diagnosed heart failure could be important in improving treatment and outcomes for these patients.
Results from the study were presented at the 2024 American Heart Association International Scientific Sessions in Chicago for peer review.
“Atrial fibrillation can make heart failure much more problematic, and more complex to treat,” said Heidi T. May, PhD, the study’s principal investigator and a cardiovascular epidemiologist at Intermountain Health. “Given these findings, screening in heart failure patients for atrial fibrillation should be ongoing, which may lead to more aggressive therapy for those who have both conditions.”
Heart failure is a condition where the heart is unable to pump blood efficiently, either due to weakened heart muscles (heart failure with reduced ejection fraction, or HFrEF) or because the heart becomes stiff and less able to fill properly with blood (heart failure with preserved ejection fraction, or HFpEF). Atrial fibrillation, on the other hand, is a type of arrhythmia where the upper chambers of the heart beat irregularly and often rapidly, disrupting the heart’s normal electrical impulses and leading to an erratic rhythm.
Although both heart failure and atrial fibrillation are known to co-occur, specific data on the incidence of this co-occurrence and how it ultimately affects a person’s health in the long-term have been lacking.
The Intermountain Health study aimed to fill this gap by reviewing the electronic health records of 21,925 patients diagnosed with new-onset heart failure between 2009 and 2019. These patients were followed for at least one year, have no history of cancer, and within 30 days of diagnosis have had an ejection fraction measurement to show how well the hearts’ lower left chamber pumps blood.
Patients with ejection fraction under 40% were categorized as heart failure with reduced ejection fraction (HFrEF) and those with an ejection fraction 40% or greater as heart failure with preserved ejection fraction (HFpEF).
They found 7,931 (36%) patients with HFrEF and 13,994 (64%) with HFpEF in their study group, with HFpEF patients on average older (74 vs. 65 years) and more often female (53.7% vs. 33.1%).
The study found that 40% of newly diagnosed heart failure patients also had atrial fibrillation. Patients with both heart failure and atrial fibrillation faced a higher likelihood of dying or being admitted to the hospital for heart failure compared to those with heart failure alone.
Interestingly, while the mortality risk was similar for both types of heart failure, those with HFrEF were more likely to be hospitalized for heart failure than those with HFpEF. This highlights the more immediate clinical urgency posed by heart failure with reduced ejection fraction, which is typically more difficult to manage and associated with poorer prognosis.
May emphasized that regular and thorough screening for atrial fibrillation should become standard practice for physicians treating heart failure. Physicians should be “extra diligent because patients with both may require a more aggressive treatment regimen to preserve their quality of life,” she said.
The research also points to the potential need for new treatment strategies. Intermountain Health researchers are now working to design a randomized clinical trial to determine the most effective treatments for patients with both heart failure and atrial fibrillation. This could include exploring the role of new heart failure medications that may offer improved outcomes for these patients.
