PMID- 10924313
OWN - NLM
STAT- MEDLINE
DCOM- 20000915
LR  - 20071115
IS  - 0195-668X (Print)
IS  - 0195-668X (Linking)
VI  - 21
IP  - 15
DP  - 2000 Aug
TI  - Prognostic value of the presence and development of atrial fibrillation in 
      patients with advanced chronic heart failure.
PG  - 1238-45
AB  - AIMS: To examine whether the presence, or development, of atrial fibrillation in 
      patients with advanced chronic heart failure, is associated with a poorer 
      prognosis, compared to patients with sinus rhythm and chronic heart failure. 
      METHODS AND RESULTS: We examined 409 patients with moderate to severe chronic 
      heart failure, and compared patients with sinus rhythm (n=325) to those with 
      atrial fibrillation (n=84). At baseline, the two groups were similar regarding 
      most indices of severity of chronic heart failure, such as left ventricular 
      ejection fraction (0.23) and New York Heart Association (NYHA) functional class, 
      while they were different for age (70 years for atrial fibrillation vs 67 years 
      for sinus rhythm patients), aetiology of chronic heart failure, blood pressure, 
      concomitant treatment, and plasma neurohormones (all P<0.05). During a mean 
      follow-up of 3.4 years (range 2.0-5.4), 203 patients (50%) died. The majority of 
      deaths was due to progressive chronic heart failure (55%) or was sudden (28%), 
      but there was no difference in mode of death between sinus rhythm and atrial 
      fibrillation patients. Overall mortality was higher in atrial fibrillation 
      patients (60%), than in those with sinus rhythm (47%; risk ratio 1.40, 95% CI 
      1.01-1.92, P=0. 04). After adjusting for important prognostic variables, such as 
      age, left ventricular ejection fraction, NYHA class, renal function, and blood 
      pressure, the presence of atrial fibrillation was no longer related to increased 
      mortality (risk ratio 0.86, range 0.59-1.24, P=ns). Of the 325 patients who had 
      sinus rhythm at baseline, 30 (9%) developed atrial fibrillation during the study. 
      These patients were older (70 vs 66 years, P<0.007), and had slightly lower blood 
      pressure and plasma norepinephrine concentrations (P<0.05), but were otherwise 
      similar. During follow-up, mortality was similar in these two groups (47% in 
      those with new onset atrial fibrillation, vs 47% in those who had sinus rhythm 
      throughout the study). CONCLUSIONS: The present data do not support the concept 
      that the presence, or the development of atrial fibrillation in patients with 
      advanced chronic heart failure is independently related to an adverse outcome 
      during long-term follow-up. The generally observed higher mortality in patients 
      with atrial fibrillation thus seems to be related to other factors, associated 
      with atrial fibrillation.
CI  - Copyright 2000 The European Society of Cardiology.
FAU - Crijns, H J
AU  - Crijns HJ
AD  - Department of Cardiology/Thoraxcenter, University Hospital Groningen, Groningen, 
      The Netherlands.
FAU - Tjeerdsma, G
AU  - Tjeerdsma G
FAU - de Kam, P J
AU  - de Kam PJ
FAU - Boomsma, F
AU  - Boomsma F
FAU - van Gelder, I C
AU  - van Gelder IC
FAU - van den Berg, M P
AU  - van den Berg MP
FAU - van Veldhuisen, D J
AU  - van Veldhuisen DJ
LA  - eng
PT  - Clinical Trial
PT  - Comparative Study
PT  - Journal Article
PT  - Multicenter Study
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
PL  - England
TA  - Eur Heart J
JT  - European heart journal
JID - 8006263
SB  - IM
CIN - Eur Heart J. 2000 Aug;21(15):1207-8. PMID: 10924307
MH  - Aged
MH  - Atrial Fibrillation/*etiology/mortality
MH  - Disease Progression
MH  - Electrocardiography
MH  - Female
MH  - Heart Failure/*complications/mortality
MH  - Heart Rate
MH  - Humans
MH  - Male
MH  - Prognosis
MH  - Prospective Studies
MH  - Survival Rate
EDAT- 2000/08/05 11:00
MHDA- 2000/09/23 11:01
CRDT- 2000/08/05 11:00
PHST- 2000/08/05 11:00 [pubmed]
PHST- 2000/09/23 11:01 [medline]
PHST- 2000/08/05 11:00 [entrez]
AID - S0195668X99921073 [pii]
AID - 10.1053/euhj.1999.2107 [doi]
PST - ppublish
SO  - Eur Heart J. 2000 Aug;21(15):1238-45. doi: 10.1053/euhj.1999.2107.