Life-Years Lost After Newly Diagnosed Atrial Fibrillation in Patients with Heart Failure

Abstract

Objective

Prior work estimated excess death rates associated with atrial fibrillation (AF) in heart failure (HF) with hazard ratios (HR). The aim was to estimate the life-years lost after newly diagnosed AF in HF patients.

Methods

Among patients diagnosed with HF in 2008–2018 in the nationwide Danish Heart Failure Registry, we compared patients with incident AF to referents matched on age, sex, and time since HF. We estimated the marginal hazard ratio (HR) for death and marginal difference in restricted mean survival times (RMST) between AF cases and referents at 10 years after AF diagnosis. We adjusted for sex, age at AF diagnosis, clinical and lifestyle risk factors, and medications.

Results

Among 4463 AF cases and 17,792 referents (mean age 73.7 years, 29% women), the HR was 1.41 (95% CI 1.38; 1.44) but there was evidence of non-proportional hazards. The difference in RMST was −18.2 months (95% CI −16.8; −19.6) at 10 years after AF diagnosis. There were differences in life-years lost between patients diagnosed with AF >1 year and ≤1 year after HF (−25.7 months, 95% CI −23.7; −27.7 vs −10.4 months, 95% CI −8.2; −12.5, p < 0.001), women and men (−20.3 months, 95% CI −17.7; −21.9 vs −17.2 months, 95% CI −15.5; −19.0, p = 0.05), patients with low, medium, and high CHA₂DS₂-VASc (10.3 months, 95% CI −4.6; −16.1 vs −18.5 months, 95% CI −16.7; −20.4 vs 22.1, 95% CI −18.8; −22.3, p = 0.002).

Conclusion

HF patients with incident AF lost on average 1.5 life-years over 10 years after AF. Life-years lost were larger among patients diagnosed with AF >1 year after HF, women, and patients with higher CHA₂DS₂-VASc.

Keywords:

• atrial fibrillation
• heart failure
• RMST
• prognosis
• mortality
• sex

Abbreviations

ACE, angiotensin-converting enzyme; AF, atrial fibrillation; ARB, angiotensin II receptor blockers; DHFR, Danish Heart Failure Registry; FHS, Framingham Heart Study; HF, heart failure; HR, hazard ratio; LVEF, left ventricular ejection fraction; MRA, mineralocorticoid receptor antagonists; NYHA, New York Heart Association; RMST, restricted mean survival time; 95% CI, 95% confidence interval.

Data Sharing Statement

Permission to access the data used in this study can be obtained following approval from the Danish Health Authority.

Disclosure

GYHL is a consultant and speaker for BMS/Pfizer, Boehringer Ingelheim and Daiichi-Sankyo. No fees are received personally. LF is a member of Advisory Boards for Pfizer, BMS and MSD. The authors report no other conflicts of interest in this work.

This project was presented at the AHA Scientific Sessions 2021 Conference as a poster presentation with interim findings. The poster’s abstract was published as Abstract 13838 in Circulation. 2021;144(Suppl_1):A13838-A13838.

Additional information

Funding

This project was supported by grants from the Health Research Fund of Central Denmark Region (R38-A1385-B1044) and The Danish Heart Foundation (16-R107-A3987). Dr Benjamin is supported in part by 2R01 HL092577; 1R01 HL141434; 2U54HL120163; 1R01AG066010; 1R01AG066914; American Heart Association, AHA_18SFRN34110082. Dr Frost is supported by the Health Research Foundation of Central Denmark Region. Dr Trinquart is supported by the American Heart Association 18SFRN34150007.