Impact of atrial fibrillation and heart failure, independent of each other and in combination, on mortality in community-dwelling older adults.

Autor: Bajaj NS; University of Alabama at Birmingham, Birmingham, Alabama; Veterans Affairs Medical Center, Birmingham, Alabama. Electronic address: nbajaj@uabmc.edu., Bhatia V; University of Alabama at Birmingham, Birmingham, Alabama; Veterans Affairs Medical Center, Birmingham, Alabama., Sanam K; University of Alabama at Birmingham, Birmingham, Alabama., Ather S; University of Alabama at Birmingham, Birmingham, Alabama; Veterans Affairs Medical Center, Birmingham, Alabama., Hashim T; University of Alabama at Birmingham, Birmingham, Alabama., Morgan C; University of Alabama at Birmingham, Birmingham, Alabama., Fonarow GC; University of California, Los Angeles, Los Angeles, California., Nanda NC; University of Alabama at Birmingham, Birmingham, Alabama., Prabhu SD; University of Alabama at Birmingham, Birmingham, Alabama; Veterans Affairs Medical Center, Birmingham, Alabama., Adamopoulos C; Papanikolaou Hospital, Thessaloniki, Greece., Kheirbek R; Veterans Affairs Medical Center, Washington, DC., Aronow WS; New York Medical College, Valhalla, New York., Fletcher RD; Veterans Affairs Medical Center, Washington, DC., Anker SD; Department of Innovative Clinical Trials, University Medical Centre Göttingen, Göttingen, Germany., Ahmed A; University of Alabama at Birmingham, Birmingham, Alabama; Veterans Affairs Medical Center, Birmingham, Alabama., Deedwania P; University of California, San Francisco, Fresno, California.
Jazyk: angličtina
Zdroj: The American journal of cardiology [Am J Cardiol] 2014 Sep 15; Vol. 114 (6), pp. 909-13.
DOI: 10.1016/j.amjcard.2014.05.045
Abstrakt: Atrial fibrillation (AF) and heart failure (HF), common in older adults, are associated with poor outcomes. However, little is known about their impact, independent of each other. We studied 5,673 community-dwelling adults aged ≥ 65 years in the Cardiovascular Health Study. Baseline prevalent AF and HF were centrally adjudicated, and 116 patients had AF only, 219 had HF only, 39 had both, and 5,263 had neither. The Cox proportional hazards model was used to estimate age-gender-race-adjusted hazard ratio (aHR) and 95% confidence intervals (CIs) for all-cause, cardiovascular (CV), and non-CV mortalities. Participants had a mean age of 73 years (± 6 years), 58% were women, and 15% African-American. During 13 years of follow-up, all-cause mortality occurred in 43%, 66%, 74%, and 85% of those with neither, AF only, HF only, and both, respectively. Compared with neither, aHR (95% CIs) for all-cause mortality associated with AF only, HF only, and both was 1.36 (1.08 to 1.72), 2.31 (1.97 to 2.71), and 3.04 (2.15 to 4.29), respectively. Similar associations were observed with CV mortality, but HF only also had greater non-CV mortality (aHR 1.72, 95% CI 1.35 to 2.18). Compared with AF alone, aHR (95% CIs) associated with HF alone for all-cause, CV, and non-CV mortalities was 1.69 (1.29 to 2.23), 1.73 (1.20 to 2.51), and 1.64 (1.09 to 2.46), respectively. Compared with HF alone, those with both conditions had greater CV but not all-cause mortality. In conclusion, community-dwelling older adults with AF have greater mortality than those without but lesser than those with HF, and both conditions were associated with greater CV and all-cause mortalities, whereas only those with HF had greater non-CV mortality.
(Copyright © 2014 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
Externí odkaz: