The Prognostic Implications of Atrial Fibrillation in Patients with Heart Failure: A Meta-Analysis

The Prognostic Implications of Atrial Fibrillation in Patients with Heart Failure: A Meta-Analysis

352 The Prognostic Implications of Atrial Fibrillation in Patients with Heart Failure: A Meta-Analysis ` Pope ∗ , Cara Wasywich, Jith Somaratne, Katri...

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352 The Prognostic Implications of Atrial Fibrillation in Patients with Heart Failure: A Meta-Analysis ` Pope ∗ , Cara Wasywich, Jith Somaratne, Katrina Adele Poppe, Rob Doughty, Gillian Whalley University of Auckland, Auckland, New Zealand Atrial fibrillation (AF) frequently coexists with heart failure (HF) and both are independently associated with worse prognosis, however, there remains controversy over the further prognostic impact of AF in patients with HF. A meta-analysis was carried out to compare mortality with AF versus sinus rhythm (SR) in patients with HF. Methods: On-line medical databases were searched for studies of patients with established HF which compared mortality by AF and SR. Analysis was performed using review manager software (V4.2.7, Cochrane Collaboration). Results: 22 studies were included (9 clinical trials, 12 clinical cohorts (9 prospective and 3 retrospective), and 1 prospective registry) involving 32,242 patients: AF, N = 5805; SR, n = 27,437. Follow-up period varied from 1 to 9 years. Patients in AF were older than those with SR (pooled mean age 70 years vs. 65 years, respectively). Pooled mean left ventricular ejection fraction (LVEF) was similar in patients with AF and SR (33.6% vs. 32.5%). A total of 11,056 patients died during follow-up (2542 in AF and 8514 in SR) giving an overall weighted odds ratio for death of 1.46 (95% CI: 1.25–1.70) in patients with AF compared to those with SR. Conclusion: This literature based meta-analysis supports the hypothesis that the presence of AF is associated with worsened prognosis for patients in HF. It is not clear whether this increased risk of mortality is directly linked to the coexistence of AF independent of other cardiovascular disease risk factors such as age, LVEF or underlying ischaemic heart disease. Further clarification would be gained from carrying out an individual patient metaanalysis. doi:10.1016/j.hlc.2008.05.353 353 The Malignant Trajectory of Heart Failure Phillip Newton 1,∗ , Patricia Davidson 1 , Amy Abernethy 2 , David Currow 3 1 Curtin

University of Technology, Sydney, NSW, Australia;

2 Duke University Medical Centre, Durham, NC, United States; 3 Flinders

University, Adelaide, SA, Australia

Background: Conceptual models have been developed which have attempted to represent the decline in physical functioning of advanced disease, in particular those with malignant conditions compared to end-stage organ failure. Aim: As part of the O2 Breathe study, a multinational, randomised double blind controlled trial of oxygen therapy in people with a progressive life limiting illness, this study sought to compare the level of physical limitation



of the heart failure (n = 29) population compared to the respiratory (n = 152) and malignant (n = 67) populations. Method: On the day of screening, participants rated their level of physical functioning and then retrospectively rated their physical functioning score for 4 weeks and 6 months previously using two scales (Australian modified Karnofsky Performance Scale and Eastern Cooperative Oncology Group scale). Results: There was an obvious decline in the level of physical functioning of the malignant group over the 6 months prior to screening. Whilst the heart failure group’s level of physical functioning remained constant throughout this period, it was significantly lower (Karnofsky p < 0.03; ECOG p < 0.02) then the respiratory group at all time points, and the malignant group for 6 months previously (Karnofsky p = 0.005; ECOG p < 0.001). There was no difference between the malignant group and the heart failure group in the four weeks up to the day of screening. Conclusion: These data support some conceptual models of the illness trajectory of advanced disease. Further studies are required that prospectively documents this trajectory. doi:10.1016/j.hlc.2008.05.354 354 Hot Weather and Heart Failure: Seasonal Variations in Morbidity and Mortality in South Australian Heart Failure Patients (1994–2005) Sally Inglis 1,3,∗ , Robyn Clark 2,3 , Sepehr Shakib 2,3 , Denis Wong 2,3 , Payman Molaee 2,3 , David Wilkinson 1,3 , Simon Stewart 1,3 of Queensland, Brisbane, Australia; 2 Royal Adelaide Hospital, Adelaide, Australia; 3 Baker Heart Research Institute, Melbourne, Australia 1 University

Background: There are minimal reports of seasonal variations in chronic heart failure (CHF)-related morbidity and mortality beyond the northern hemisphere. What influence high summer temperatures and milder winter temperatures have on CHF morbidity and mortality of is yet to be determined. Method: We retrospectively analysed longitudinal routinely collected clinical data for 2961 patients with a confirmed diagnosis of CHF from a tertiary referral hospital in Southern Australia and examined the potential seasonal variations in respect to morbidity and all-cause mortality over more than a decade. Results: Seasonal variation across all event-types was observed. CHF-related hospitalisations peaked in winter (July) and were lowest in summer (February): 70 (95% CI: 65–76) vs. 33 (95% CI: 30–37) admissions/1000 at risk (p < 0.005). All-cause hospitalisations were consistently higher in winter (113 (95% CI: 107–120) vs. 73 (95% CI: 68–79) admissions/1000 at risk, p < 0.001). The proportion of concurrent respiratory disease was also consistently higher in winter (21% vs. 12%, p < 0.001). All-cause mortality was highest in August (winter) relative to February (summer): 23 (95% CI: 20–27) vs. 12 (95% CI: 10–15) deaths per 1000 at


Heart, Lung and Circulation 2008;17S:S1–S209