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

Figures & data

Table 1 Characteristics of HF Patients with Incident AF and Matched Referents

	AF Cases N = 4463	Referents without AF N = 17,792
Demographics
Age, years, mean (SD)	73.7 (11.4)	73.6 (11.3)
Female sex	1295 (29.0)	5148 (28.9)
Lifestyle factors
Elevated alcohol consumption	362 (9.5)	1265 (8.3)
Smoking status
Never	1065 (26.7)	4175 (25.7)
Former	1857 (46.6)	7530 (46.4)
Current	1064 (26.7)	4518 (27.9)
Clinical data
LVEF
<25%	1076 (24.7)	3654 (21.0)
25–40%	2671 (61.4)	11,140 (64.0)
>40–49%	296 (6.8)	1293 (7.4)
≥50%	311 (7.1)	1309 (7.5)
NYHA class
I	499 (12.7)	2692 (16.6)
II	2361 (59.9)	9959 (61.3)
III/IV	1082 (27.5)	3592 (21.8)
Time since HF, years, median (Q1–Q3)	1.75 (0.82–3.95)	1.75 (0.82–3.93)
Age at HF diagnosis, years, mean (SD)	71.5 (11.4)	71.5 (11.3)
History of comorbidity
Myocardial infarction	1397 (31.3)	6040 (34.0)
Any stroke/TIA	694 (15.6)	1889 (10.6)
Diabetes mellitus	969 (21.7)	3177 (16.9)
COPD	713 (16.0)	2103 (11.8)
Hypertension	2098 (47.0)	7430 (41.8)
Chronic kidney disease	468 (10.5)	1255 (7.1)
Overweight/obesity*	390 (8.7)	1018 (5.7)
Cancer	665 (14.9)	2099 (11.8)
Current HF medication**
ACE inhibitors/ARBs	2841 (63.7)	9579 (53.8)
Beta-blockers	2679 (60.0)	8928 (50.2)
MRAs	1036 (23.2)	3333 (18.7)

Notes: We matched each HF patient with incident AF to up to 4 referents on age at diagnosis of HF, sex, and time since diagnosis of HF. Characteristics were collected at the time of AF diagnosis or corresponding age for referents, except alcohol consumption, smoking status, LVEF, and NYHA, which were collected at the time of HF diagnosis. Age is on the index date, which is AF diagnosis for AF cases. Missing, N (%): alcohol consumption: 3250 (14.6), smoking: 2046 (9.2), LVEF: 505 (2.3), NYHA: 2070 (9.3). *Defined by ICD codes. **Defined as fulfilling at least 1 prescription within 6 months prior to the index date.

Abbreviations: AF, atrial fibrillation; LVEF, left ventricular ejection fraction; NYHA, New York Heart Association; HF, heart failure; TIA, transient ischemic attack; COPD, chronic obstructive pulmonary disease; ACE, angiotensin converting enzyme; ARB, angiotensin receptor blocker; MRA, mineralocorticoid receptor antagonist.

Table 2 Differences in Marginal Cumulative Mortality Risks and Restricted Mean Survival Times Between HF Patients with and without AF

	Time After Diagnosis of AF
	1 Year	5 Years	10 years
Marginal cumulative mortality (%)
HF patients with AF	18.4 (17.6–19.2)	54.1 (52.8–55.4)	76.5 (75.1–78.0)
HF patients without AF	10.3 (9.9–10.7)	36.4 (35.6–37.2)	59.6 (58.1–61.1)
Risk difference	8.1 (7.4–8.8)	17.7 (16.3–19.1)	17.0 (15.7–18.3)
Marginal restricted mean survival times (months)
HF patients with AF	10.7 (10.6–10.7)	40.3 (39.8–40.9)	60.2 (58.9–61.5)
HF patients without AF	11.3 (11.2–11.3)	47.8 (47.5–48.1)	78.8 (77.6–79.3)
Difference in RMST	−0.6 (−0.6–−0.7)	−7.5 (−6.8–−8.1)	−18.2 (−16.8–−19.6)

Notes: HF patients with and without AF were matched on age, sex, and time since HF. Analyses were adjusted for all covariates in Table 1. Over the 10 years following their AF diagnosis, HF patients can expect to live for 60.2 months ~ 5 years. Over 10 years following their AF diagnosis, HF patients with AF will live 18.2 month ~1.5 years less as compared to HF patients without AF.

Abbreviation: RMST, restricted mean survival times.

Figure 1 (A) Marginal survival curves, (B) marginal restricted mean survival times, and (C) difference between marginal restricted mean survival times with 95% confidence interval. Marginal curves adjusted for characteristics in Table 1.

Table 3 Difference in Marginal Cumulative Mortality Risks and Restricted Mean Survival Times at 10 Years Between HF Patients with and without AF Among Subgroups

	Numbers of AF Cases/Referents	Difference in 10-Year Mortality Risk Between HF Patients with and without AF (%)	P value Between Subgroups	Difference in 10-Year RMST Between HF Patients with and without AF (Months)	P value Between Subgroups
AF diagnosis >1 year of HF diagnosis	2384/9712	22.2 (20.5–24.0)	<0.001	−25.7 (−23.7–−27.7)	<0.001
AF diagnosis ≤ 1 year of HF diagnosis	2079/8080	10.3 (8.2–12.3)		−10.4 (−8.2–−12.5)
Women	1295/5148	16.7 (14.6–18.9)	0.94	−20.3 (−17.7–−22.9)	0.05
Men	3168/12,644	16.8 (15.2–18.4)		−17.2 (−15.5–−19.0)
Age ≥75 years	1875/7464	12.9 (11.4–14.5)	<0.001	−20.1 (−17.9–−22.2)	0.16
Age <75 years	2588/10,328	21.8 (19.3–24.4)		−17.8 (−15.6–−20.0)
LVEF ≤40%	3747/14,930	16.9 (15.5–18.4)	0.76	−17.9 (−16.3–−19.5)	0.62
LVEF >40-<50%	286/1082	17.8 (12.3–23.4)		−18.1 (−12.3–−23.9)
LVEF ≥50%	305/1123	18.7 (13.9–23.6)		−20.7 (−15.2–−26.3)
CHA2DS2-VASc low	382/1520	13.5 (6.1–20.9)	0.50	−10.3 (−4.6–−16.1)	0.002
CHA2DS2-VASc medium	2959/11,801	17.7 (16.0–19.4)		−18.5 (−16.7–−20.4)
CHA2DS2-VASc high	1122/4471	16.8 (14.4–19.3)		−22.1 (−18.8–−22.3)

Notes: Adjusted for all covariates in Table 1, except the variable used to stratify. CHA₂DS₂VASc groups: Low: women 1–2; men 1. Medium: women 3–5; men 2–4. High: women >5; men >4.

Abbreviations: AF, atrial fibrillation; RMST, restricted mean survival time; LVEF, left ventricular ejection fraction.