Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access
Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc
Journal website https://www.cardiologyres.org

Original Article

Volume 15, Number 1, February 2024, pages 37-46


Characteristics and Outcomes of Atrial Fibrillation in Chronic Heart Failure Patients: A Comprehensive Analysis of the Colombian Heart Failure Registry

Figures

Figure 1.
Figure 1. Prescription rates of HF medications based on AF diagnosis. ACEI: angiotensin-converting enzyme inhibitor; ARB: angiotensin receptor blocker; ARNI: angiotensin receptor neprilysin inhibitor; AF: atrial fibrillation; HF: heart failure; MRA: mineralocorticoid receptor antagonist.
Figure 2.
Figure 2. Summary of findings from the RECOLFACA study regarding atrial fibrillation (AF) in chronic HF patients. RECOLFACA: the Colombian Heart Failure Registry; ECG: electrocardiogram; ICD: implantable cardioverter defibrillator; CRT: cardiac resynchronization therapy; HFrEF: heart failure with reduced ejection fraction.

Tables

Table 1. Sociodemographic and Clinical Characteristics Based on Atrial Fibrillation Diagnosis
 
No AF (n = 1,954) n (%)AF (n = 560), n (%)Total (n = 2,514), n (%)P value
*P < 0.05. This table contains absolute counts and percentages (%) for categorical variables and mean and SD for continuous variables. n: refers to the total number of patients that report having/not having each condition. ACC: American College of Cardiology; AHA: American Heart Association; CABG: coronary artery bypass graft; COPD: chronic obstructive pulmonary disease; CRT: cardiac resynchronization therapy; GFR: glomerular filtration rate; HR: heart rate; bpm: beats per minute; ICD: implantable cardioverter defibrillator; LVDD: left ventricular diastolic diameter; LVEF: left ventricle ejection fraction; NT-proBNP: N-terminal prohormone of brain natriuretic peptide; NYHA: New York Heart Association; PM: pacemaker; SD: standard deviation; IQR: interquartile range.
Demographics
  Age (years), mean ± SD66.00 ± 14.0073.00 ± 11.0067.00 ± 14.00< 0.001*
  Sex0.272
    Female818 (41.9)249 (44.5)1,067 (42.4)
    Male1,136 (58.1)311 (55.5)1,447 (57.6)
  Population0.824
    Asian1 (0.1)0 (0.0)1 (0.0)
    European86 (4.4)30 (5.4)116 (4.6)
    Native American9 (0.5)1 (0.2)10 (0.4)
    Hispanic1,444 (73.9)409 (73.0)1,853 (73.7)
    Mestizo354 (18.1)104 (18.6)458 (18.2)
    African-American60 (3.1)16 (2.9)76 (3.0)
  Insurance information
    Contributive1,115 (57.1)355 (63.4)1,470 (58.5)< 0.001*
    Subsidized748 (38.3)149 (26.6)897 (35.7)
    Additional insurance policy91 (4.7)56 (10.0)147 (5.8)
Comorbidities
  Hypertension1,382 (70.7)429 (76.6)1,811 (72.0)0.006
  Type 2 diabetes mellitus516 (26.4)104 (18.6)620 (24.7)< 0.001*
  Cancer78 (4.0)23 (4.1)101 (4.0)0.902
  Coronary artery disease565 (28.9)141 (25.2)706 (28.1)0.083
  COPD315 (16.1)126 (22.5)441 (17.5)< 0.001*
  Thyroid disease257 (13.2)131 (23.4)388 (15.4)< 0.001*
  Chronic kidney disease307 (15.7)127 (22.7)434 (17.3)< 0.001*
  Valvular disease297 (15.2)132 (23.6)429 (17.1)< 0.001*
  Smoking362 (18.5)90 (16.1)452 (17.9)0.182
  CABG139 (7.1)31 (5.5)170 (6.8)0.190
  Dyslipidemia513 (26.3)134 (23.9)647 (25.7)0.267
  Chagas disease70 (3.6)18 (3.2)88 (3.5)0.676
Heart failure information
  NYHA classification0.488
    I242 (12.4)56 (10.0)298 (11.9)
    II1042 (53.3)308 (55.0)1,350 (53.7)
    III577 (29.5)170 (30.4)747 (29.7)
    IV93 (4.8)26 (4.6)119 (4.7)
  AHA/ACC stage0.171
    C1,854 (94.9)523 (93.4)2,377 (94.6)
    D100 (5.1)37 (6.6)137 (5.4)
  Bicameral PM60 (3.1)38 (6.8)98 (3.9)< 0.001*
  Unicameral PM28 (1.4)21 (3.8)49 (1.9)< 0.001*
  CRT39 (2.0)9 (1.6)48 (1.9)0.553
  ICD184 (9.4)59 (10.5)243 (9.7)0.429
  CRT + ICD84 (4.3)43 (7.7)127 (5.1)0.001*
  HR (bpm), median (IQR)72 (65, 80)70 (64, 83)72 (65, 81)0.832
  QRS complex0.190
    < 120 ms635 (61.4)198 (65.6)833 (62.4)
    > 120 ms399 (38.6)104 (34.4)503 (37.7)
  LVDD mm56.595 (12.493)55.089 (12.626)56.270 (12.532)0.032
  LVEF %33.978 (13.432)35.293 (13.672)34.261 (13.491)0.067
  Pulmonary hypertension on echocardiogram649 (45.5)241 (59.5)890 (48.6)< 0.001*
  Quality of life score79.742 (20.383)75.616 (22.487)78.823 (20.936)< 0.001*
Laboratory results
  Hemoglobin, mg/dL12.966 (2.098)12.944 (2.041)12.961 (2.084)0.980
  Creatinine, mg/dL1.349 (1.050)1.310 (0.690)1.340 (0.979)0.010
  GFR63.729 (35.912)59.116 (26.455)62.666 (34.016)0.031
  Hyperkalemia142 (9.9)34 (7.7)176 (9.4)0.146
  Hyponatremia193 (14.8)47 (11.6)240 (14.1)0.111
  Blood urea nitrogen25.965 (14.052)27.937 (14.087)26.413 (14.080)0.002*
  NTproBNP, pg/mL5,506.983 (8,508.236)5,925.434 (10,806.911)5,625.510 (9,205.680)0.417

 

Table 2. Sociodemographic and Clinical Characteristics of Patients With HF and Atrial Fibrillation Based on Ejection Fraction
 
HFpEF (n = 275), n (%)HFrEF (n = 285), n (%)Total (n = 560), n (%)P value
This table contains absolute counts and % for categorical variables and mean and SD for continuous variables. n: refers to the total number of patients that report having/not having each condition. SD: standard deviation; ACC: American College of Cardiology; AHA: American Heart Association; ARB: aldosterone receptor blocker; CABG: coronary artery bypass graft; COPD: chronic obstructive pulmonary disease; CRT: cardiac resynchronization therapy; GFR: glomerular filtration rate; ICD: implantable cardioverter defibrillator; LVDD: left ventricle diastolic diameter; LVEF: left ventricle ejection fraction; MRA: mineralocorticoid receptor antagonist; NT-proBNP: N-terminal prohormone of brain natriuretic peptide; NYHA: New York Heart Association; PM: pacemaker; ACE: angiotensin-converting enzyme; HFpEF: heart failure with preserved ejection fraction; HFrEF: heart failure with reduced ejection fraction.
Demographics
  Age (years), mean ± SD75.21 ± 10.0670.95 ± 10.6173.04 ± 10.55< 0.001
  Sex
    Female136 (49.5)113 (39.6)249 (44.5)
    Males139 (50.5)172 (60.4)311 (55.5)0.020
  Population0.661
    European15 (5.5)15 (5.3)30 (5.4)
    Indigenous0 (0.0)1 (0.4)1 (0.2)
    Hispanic197 (71.6)212 (74.4)409 (73.0)
    Mestiza53 (19.3)51 (17.9)104 (18.6)
    African-American10 (3.6)6 (2.1)16 (2.9)
  Comorbidities
    Hypertension217 (78.9)212 (74.4)429 (76.6)0.206
    Type 2 diabetes mellitus57 (20.7)47 (16.5)104 (18.6)0.198
    Coronary disease72 (26.2)69 (24.2)141 (25.2)0.591
    COPD68 (24.7)58 (20.4)126 (22.5)0.215
    Thyroid disease76 (27.6)55 (19.3)131 (23.4)0.020
    Chronic kidney disease57 (20.7)70 (24.6)127 (22.7)0.279
    Valvular disease71 (25.8)61 (21.4)132 (23.6)0.219
    Smoking50 (18.2)40 (14.0)90 (16.0)0.182
    CABG17 (6.2)14 (4.9)31 (5.5)0.511
    Dyslipidemia59 (21.5)75 (26.3)134 (23.9)0.178
    Chagas disease4 (1.5)14 (4.9)18 (3.2)0.020
Heart failure information
  HF etiology
    Hypertensive118 (42.9)103 (36.1)221 (39.5)0.101
    Toxic3 (1.1)1 (0.4)4 (0.7)0.365
    Ischemic108 (39.3)109 (38.2)217 (38.8)0.803
    Unknown000
    Valvular78 (28.4)58 (20.4)136 (24.3)0.027
    Other000
    Chemotherapy2 (0.7)2 (0.7)4 (0.7)1.000
    Idiopathic19 (6.9)19 (6.7)38 (6.8)0.909
    Tachycardiomyopathy58 (21.1)73 (25.6)131 (23.4)0.206
    Metabolic5 (1.8)8 (2.8)13 (2.3)0.437
    Chagasic3 (1.1)13 (4.6)16 (2.9)0.014
    Congenital2 (0.7)2 (0.7)4 (0.7)1.000
    Viral1 (0.4)0 (0.0)1 (0.2)0.491
    Genetic1 (0.4)0 (0.0)1 (0.2)0.491
    Peripartum0 (0.0)1 (0.4)1 (0.2)1.000
    Alcoholic0 (0.0)1 (0.4)1 (0.2)1.000
  NYHA classification0.153
    I25 (9.1)31 (10.9)56 (10.0)
    II151 (54.9)157 (55.1)308 (55.0)
    III91 (33.1)79 (27.7)170 (30.4)
    IV8 (2.9)18 (6.3)26 (4.6)
  AHA/ACC stage0.079
    C262 (95.3)261 (91.6)523 (93.4)
    D13 (4.7)24 (8.4)37 (6.6)
  Bicameral PM25 (9.1)13 (4.6)38 (6.8)0.033
  Unicameral PM13 (4.7)8 (2.8)21 (3.8)0.232
  CRT4 (1.5)5 (1.8)9 (1.6)0.957
  ICD24 (8.7)35 (12.3)59 (10.5)0.171
  CRT + ICD8 (2.9)35 (12.3)43 (7.7)< 0.001
  Prolonged QRS43 (31)61 (37)104 (34.4)0.237
  LVDD, mm48.516 (10.170)58.220 (12.499)55.089 (12.626)< 0.001
  LVEF50.406 (8.634)27.074 (7.487)35.293 (13.672)< 0.001
  Pulmonary hypertension on echocardiogram94 (64.4)147 (56.8)241 (59.5)0.133
  Quality of life score77.018 (21.525)74.263 (23.335)75.616 (22.487)0.195
Pharmacological treatment
  ACE inhibitors77 (28.0)95 (33.3)172 (30.7)0.171
  ARB136 (49.5)119 (41.8)255 (45.5)0.067
  Diuretics205 (74.5)217 (76.1)422 (75.4)0.661
  Beta-blockers248 (90.2)268 (94.0)516 (92.1)0.090
  Sacubitril/valsartan17 (6.2)39 (13.7)56 (10.0)0.003
  MRAs131 (47.6)192 (67.4)323 (57.7)< 0.001
  Ivabradine2 (0.7)5 (1.8)7 (1.2)0.274
  Digoxin41 (14.9)58 (20.4)99 (17.7)0.091
  Nitrates11 (4.0)5 (1.8)16 (2.9)0.111
  Antiaggregants67 (24.4)66 (23.2)133 (23.8)0.737
  Statins148 (53.8)171 (60.0)319 (57.0)0.140
  Anticoagulants194 (70.5)183 (64.2)377 (67.3)0.110
Laboratory findings
  Hemoglobin, mg/dL12.631 (2.152)13.243 (1.886)12.944 (2.041)0.005
  Serum creatinine, mg/dL1.255 (0.630)1.361 (0.739)1.310 (0.690)0.013
  GFR61.905 (25.763)56.499 (26.877)59.116 (26.455)0.007
  Blood urea nitrogen26.717 (13.971)29.033 (14.139)27.937 (14.087)0.050
  Hyperkalemia16 (7.3)18 (7.9)34 (7.7)0.804
  Hyponatremia28 (13.9)19 (9.4)47 (11.6)0.152
  NT-proBNP, pg/mL4,975.927 (12,335.601)6,795.815 (9,207.515)5,925.434 (10,806.911)0.177