Evaluation of Clinical, Echocardiographic, and Therapeutic Characteristics, and Prognostic Outcomes of Coexisting Heart Failure among Patients with Atrial Fibrillation: The Jordan Atrial Fibrillation (JoFib) Study

Background: Atrial fibrillation (AF) is the most commonly encountered cardiac arrhythmia in clinical practice. Heart failure (HF) can occur concurrently with AF. Aim: We compared different demographic, clinical, and echocardiographic characteristics between patients with AF+HF and patients with AF only. Furthermore, we explored whether concurrent HF independently predicts several outcomes (all-cause mortality, cardiovascular mortality, ischemic stroke/systemic embolism (IS/SE), major bleeding, and clinically relevant non-major bleeding (CRNMB)). objective: In this study, we compared different demographic, clinical, and echocardiographic characteristics between patients with both HF and AF and patients with only AF. Furthermore, we explored whether concurrent HF independently predicts the occurrence of several outcomes (all-cause mortality, cardiovascular mortality, ischemic stroke/ systemic embolism (IS/SE), major bleeding, and clinically relevant non-major bleeding (CRNM)). Materials and Methods: Comparisons between the AF+HF and the AF-only group were carried out. Multivariable Cox proportional hazard models were constructed for each outcome to assess whether HF was predictive of any of them while controlling for possible confounding factors. method: Comparisons between the AF patients with concomitant HF (HF+AF) group and the AF group were done using chi-square tests and independent t-tests for categorical variables and continuous variables, respectively. Also, multivariable logistic regression was performed for each outcome to assess whether HF was predictive of any of them while controlling for possible confounding factors. Results: A total of 2020 patients were included in this study: 481 had AF+HF; 1539 had AF only. AF+HF patients were older, more commonly males, and had a higher prevalence of diabetes mellitus, dyslipidemia, coronary artery disease, and chronic kidney disease (p≤0.05). Furthermore, AF+HF patients more commonly had pulmonary hypertension and low ejection fraction (p≤0.001). Finally, HF was independently predictive of all-cause mortality (adjusted HR 2.17, 95% CI (1.66-2.85) and cardiovascular mortality (adjusted HR 2.37, 95% CI (1.68-3.36). result: A total of 2020 patients were included in this study, of which 481 had both AF and HF while 1539 had AF only. (AF+HF) patients were older, more commonly male, and had higher prevalence of diabetes mellitus, dyslipidemia, coronary artery disease, and chronic kidney disease (p≤0.05). Furthermore, (AF+HF) patients more commonly had pulmonary hypertension and low ejection fraction (p≤0.001). Finally, HF was independently predictive of all-cause mortality (OR=2.51, 95% CI 1.86 to 3.38), cardiovascular mortality (OR=2.69, 95% CI 1.89 to 3.83), and major bleeding (OR 1.91, 95% CI 1.04 to 3.51) but did not significantly predict (IS/SE). Conclusion: Coexisting AF+HF was associated with a more labile and higher-risk population among Jordanian patients. Furthermore, coexisting HF independently predicted higher all-cause mortality and cardiovascular mortality. Efforts should be made to efficiently identify such cases early and treat them aggressively. conclusion: Coexisting HF among AF patients was associated with a more labile and higher-risk population among Jordanian AF patients. Furthermore, coexisting HF independently predicted higher mortality and major bleeding complications but not ischemic stroke/systemic embolism. Serious efforts should be taken to efficiently identify such cases early and treat them aggressively along with other related risk factors.