Author + information
- Ratika Parkash, MD, MSc⁎ ( and )
- William G. Stevenson, MD
- ↵⁎QEII Health Science Centre, 1796 Summer Street, Room 2501D, Halifax, Nova Scotia B3H 3A7, Canada
The study by Olsson et al. (1) found that atrial fibrillation (AF) is associated with a worse outcome in patients with heart failure (HF) regardless of whether HF is associated with depressed or relatively preserved ventricular function, although those with preserved left ventricular (LV) function had better survival than did those with depressed LV function. In a series of 478 patients hospitalized with AF and HF we observed that those with preserved LV function had a similarly poor prognosis as did those with depressed LV function when adjusted for age, gender, coronary artery disease, and comorbid illness (2).
Differences in these findings might be illuminating. Whereas the CHARM (Candesartan in Heart failure-Assessment of Reduction in mortality and morbidity) program enrolled stable HF patients, our study population were patients who had a deterioration necessitating hospitalization. We observed a steep increase in mortality shortly after the index hospitalization, suggesting that such an event is a potent marker for mortality warranting aggressive management. We also found an association between decreased mortality and statin therapy, intriguing in view of recent speculation that inflammation and fibrosis may be involed in promoting AF. It would be of interest to know whether intercurrent development of AF had a different prognosis as compared to preexisting AF in CHARM and whether statin therapy disproportionately affects outcomes.
- American College of Cardiology Foundation
- Olsson L.G.,
- Swedberg K.,
- Ducharme A.,
- et al.