Atrial Fibrillation, Heart Failure Phenotypes, and Mortality Risk in the Nationwide START Registry: A Propensity Score Matching Analysis
Background Data on atrial fibrillation (AF) and heart failure (HF) with preserved ejection fraction (HFpEF) are scarce. We investigated the association of HFpEF with all‐cause mortality in AF. Methods We included 10 369 patients with AF on oral anticoagulants from the nationwide ongoing START (Surve...
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Wiley
2025-06-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
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| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.125.042586 |
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| author | Danilo Menichelli Emilia Antonucci Gianluca Gazzaniga Daniela Poli Giuseppe Armentaro Giordano di Carlo Rossella Marcucci Paolo Calabrò Arturo Cesaro Gualtiero Palareti Angela Sciacqua Pasquale Pignatelli Daniele Pastori |
| author_facet | Danilo Menichelli Emilia Antonucci Gianluca Gazzaniga Daniela Poli Giuseppe Armentaro Giordano di Carlo Rossella Marcucci Paolo Calabrò Arturo Cesaro Gualtiero Palareti Angela Sciacqua Pasquale Pignatelli Daniele Pastori |
| author_sort | Danilo Menichelli |
| collection | DOAJ |
| description | Background Data on atrial fibrillation (AF) and heart failure (HF) with preserved ejection fraction (HFpEF) are scarce. We investigated the association of HFpEF with all‐cause mortality in AF. Methods We included 10 369 patients with AF on oral anticoagulants from the nationwide ongoing START (Survey on Anticoagulated Patients Register) registry. Patients were divided into 3 groups: (1) no HF, (2) HF with reduced EF/HF with mildly reduced EF (EF ≤50%), and HFpEF (EF >50%). Patients with HF should have had a clinical diagnosis or a history of HF hospitalization. The association between HF types and all‐cause mortality was investigated by Cox proportional hazards regression analysis to estimate hazard ratio (HR) and 95% CI for each factor. The Fine–Gray model and propensity score matching were used. Results Mean age was 76.4±9.4 years and 45.8% were women. Overall, 2309 (22.2%) patients had HF, of whom 47.4% had HFpEF. During 720±576 days of follow‐up (20 747 patients/year), 727 deaths occurred (3.5 per 100 patient‐years). After propensity score matching, both HF with mildly reduced EF/HF with reduced EF and HFpEF were associated with all‐cause mortality (HR, 1.33; P=0.037 and HR, 1.49; P=0.004). HFpEF was associated with mortality in men (HR, 1.654; P=0.001) but not in women (HR, 1.243; P=0.175). In HFpEF, age≥75 years (HR, 2.247; P=0.003), chronic respiratory disease (HR, 2.109; P<0.001), anemia (HR, 1.482; P=0.035), paroxysmal AF (HR, 0.528; P=0.012), creatinine clearance<30 mL/min (HR, 1.791; P=0.018), direct oral anticoagulants (HR, 0.575; P=0.005), and renin‐angiotensin inhibitors (HR, 0.670; P=0.033) were associated with all‐cause mortality. Conclusions HFpEF is frequent in patients with AF and associated with an increased mortality, especially in men. Comorbidities and treatments associated differently with mortality according to HF phenotype. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02219984. |
| format | Article |
| id | doaj-art-19e862d18fed4e379a018766efa77e03 |
| institution | Kabale University |
| issn | 2047-9980 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Wiley |
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| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-19e862d18fed4e379a018766efa77e032025-08-20T03:50:00ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802025-06-01141210.1161/JAHA.125.042586Atrial Fibrillation, Heart Failure Phenotypes, and Mortality Risk in the Nationwide START Registry: A Propensity Score Matching AnalysisDanilo Menichelli0Emilia Antonucci1Gianluca Gazzaniga2Daniela Poli3Giuseppe Armentaro4Giordano di Carlo5Rossella Marcucci6Paolo Calabrò7Arturo Cesaro8Gualtiero Palareti9Angela Sciacqua10Pasquale Pignatelli11Daniele Pastori12Department of General Surgery and Surgical Specialty Paride Stefanini Sapienza University of Rome Rome ItalyFondazione Arianna Anticoagulazione Bologna ItalyDepartment of General Surgery and Surgical Specialty Paride Stefanini Sapienza University of Rome Rome ItalyCenter of Atherothrombotic Disease Azienda Ospedaliero‐Universitaria Careggi Florence ItalyDepartment of Medical and Surgical Sciences University Magna Græcia of Catanzaro Catanzaro ItalyPostgraduate School of Internal Medicine, Department of Internal Medicine and Medical Specialties Sapienza University of Rome Rome ItalyDepartment of Clinical and Experimental Medicine University of Florence Florence ItalyDepartment of Translational Medical Sciences University of Campania “Luigi Vanvitelli” Caserta ItalyDepartment of Translational Medical Sciences University of Campania “Luigi Vanvitelli” Caserta ItalyFondazione Arianna Anticoagulazione Bologna ItalyDepartment of Medical and Surgical Sciences University Magna Græcia of Catanzaro Catanzaro ItalyDepartment of Clinical Internal, Anesthesiological and Cardiovascular Sciences Sapienza University of Rome Rome ItalyDepartment of Clinical Internal, Anesthesiological and Cardiovascular Sciences Sapienza University of Rome Rome ItalyBackground Data on atrial fibrillation (AF) and heart failure (HF) with preserved ejection fraction (HFpEF) are scarce. We investigated the association of HFpEF with all‐cause mortality in AF. Methods We included 10 369 patients with AF on oral anticoagulants from the nationwide ongoing START (Survey on Anticoagulated Patients Register) registry. Patients were divided into 3 groups: (1) no HF, (2) HF with reduced EF/HF with mildly reduced EF (EF ≤50%), and HFpEF (EF >50%). Patients with HF should have had a clinical diagnosis or a history of HF hospitalization. The association between HF types and all‐cause mortality was investigated by Cox proportional hazards regression analysis to estimate hazard ratio (HR) and 95% CI for each factor. The Fine–Gray model and propensity score matching were used. Results Mean age was 76.4±9.4 years and 45.8% were women. Overall, 2309 (22.2%) patients had HF, of whom 47.4% had HFpEF. During 720±576 days of follow‐up (20 747 patients/year), 727 deaths occurred (3.5 per 100 patient‐years). After propensity score matching, both HF with mildly reduced EF/HF with reduced EF and HFpEF were associated with all‐cause mortality (HR, 1.33; P=0.037 and HR, 1.49; P=0.004). HFpEF was associated with mortality in men (HR, 1.654; P=0.001) but not in women (HR, 1.243; P=0.175). In HFpEF, age≥75 years (HR, 2.247; P=0.003), chronic respiratory disease (HR, 2.109; P<0.001), anemia (HR, 1.482; P=0.035), paroxysmal AF (HR, 0.528; P=0.012), creatinine clearance<30 mL/min (HR, 1.791; P=0.018), direct oral anticoagulants (HR, 0.575; P=0.005), and renin‐angiotensin inhibitors (HR, 0.670; P=0.033) were associated with all‐cause mortality. Conclusions HFpEF is frequent in patients with AF and associated with an increased mortality, especially in men. Comorbidities and treatments associated differently with mortality according to HF phenotype. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02219984.https://www.ahajournals.org/doi/10.1161/JAHA.125.042586AFatrial fibrillationheart failureHFpEFHFrEF/HFmrEFmortality |
| spellingShingle | Danilo Menichelli Emilia Antonucci Gianluca Gazzaniga Daniela Poli Giuseppe Armentaro Giordano di Carlo Rossella Marcucci Paolo Calabrò Arturo Cesaro Gualtiero Palareti Angela Sciacqua Pasquale Pignatelli Daniele Pastori Atrial Fibrillation, Heart Failure Phenotypes, and Mortality Risk in the Nationwide START Registry: A Propensity Score Matching Analysis Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease AF atrial fibrillation heart failure HFpEF HFrEF/HFmrEF mortality |
| title | Atrial Fibrillation, Heart Failure Phenotypes, and Mortality Risk in the Nationwide START Registry: A Propensity Score Matching Analysis |
| title_full | Atrial Fibrillation, Heart Failure Phenotypes, and Mortality Risk in the Nationwide START Registry: A Propensity Score Matching Analysis |
| title_fullStr | Atrial Fibrillation, Heart Failure Phenotypes, and Mortality Risk in the Nationwide START Registry: A Propensity Score Matching Analysis |
| title_full_unstemmed | Atrial Fibrillation, Heart Failure Phenotypes, and Mortality Risk in the Nationwide START Registry: A Propensity Score Matching Analysis |
| title_short | Atrial Fibrillation, Heart Failure Phenotypes, and Mortality Risk in the Nationwide START Registry: A Propensity Score Matching Analysis |
| title_sort | atrial fibrillation heart failure phenotypes and mortality risk in the nationwide start registry a propensity score matching analysis |
| topic | AF atrial fibrillation heart failure HFpEF HFrEF/HFmrEF mortality |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.125.042586 |
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