Effectiveness of control over hemodynamic indexes and prognosis for patients with CHF and atrial fibrillation in real-life clinical practice

Background. Earlier studies have demonstrated a high prevalence of atrial fibrillation (AF) in patients with CHF. It was noticed that tachycardia and hypotension provoked high risks for cardiovascular mortality. The presence of arterial hypertension (AH) in CHF patients also impairs life prognosis. Aim. To determine prognosis for patients based on the control of hemodynamic indexes and titration of pulse-slowing therapy in real-life clinical practice. Materials and methods. This prospective study with a one-year follow-up period included 580 patients after decompensated CHF who were discharged from the Municipal Center for Treatment of CHF. 46.9% of patients had AF. Patients with AF were divided into groups with paroxysmal and persistent AF (combined) and permanent AF. Results. Among patients with CHF and AF, 56.3%, 38.6%, and 5.1% had permanent, persistent, and paroxysmal AF, respectively. Patients with permanent AF had a higher CHF FC. The FC was evaluated using the 6-min walk test and Clinical Condition Scale at baseline and after the one-year follow-up. Incidence of hypotension and tachycardia was higher in the group with permanent AF. In patients without AF, baseline systolic blood pressure (SBP) (139.5±24.5 mm Hg) was higher than in patients with any AF type (132.1±24.2 mm Hg, p<0.001), paroxysmal and persistent AF (133.1±23.9 mm Hg, p=0.015), or permanent AF (131.3±24.6 mm Hg, p<0.001). After the one-year follow-up, SBP values decreased in the study groups to 127.7±18.5 mm Hg (p=0.02) for patients with AF; and to 133.5±21.4 mm Hg (р=0.002) for patients without AF. A statistically significant decrease in DBP was observed only in the group without AF. Heart rate significantly decreased only in patients with permanent AF (from 84.5±18.1 bpm to 79.7±15.8 bpm, р=0.017) and in patients without AF (from 73.9±14.0 bpm to 70.4±14.0 bpm, р=0.002). In a year of follow-up, the beta-blocker coverage increased with a statistically non-significant increase in beta-blocker doses. Risk for all-cause death was increased 1.9 times (odds ratio (OR), 1.9; 95% confidence interval (CI), 1.0-3.4; р=0.035) in combined CHF and AF; and 2.3 times in permanent AF (OR, 2.3; 95% CI 1.2-4.4; р=0.012) compared with CHF without AF. In persistent and paroxysmal AF, statistically significant increases in death risks were not observed. The risk for cardiovascular death was also increased in the AF group compared to patients without AF (7.7 vs. 4.5%, OR=1.8; 95% CI: 0.9-3.5, р=0.11). Acute decompensation of HF prevailed in the structure of cardiovascular mortality in patients with AF (86.4% of cases). Risks of nonfatal cardiovascular complications for patients with CHF and AF were comparable with risks for patients without AF (3.3 and 3.2% of cases per year (OR=1.0; 95% CI: 0.4-2.5; р=0.97). AF increased the risk of repeated hospitalization in CHF patients by 46.8% (OR=1.8; 95% CI: 1.2-2.5; р=0.001). Conclusion. The presence of any AF type, particularly permanent AF, considerably aggravated CHF due to hypotension and tachycardia. The presence of permanent AF associated with CHF increased risks for all-cause and cardiovascular death, nonfatal cardiovascular complications, and repeated hospitalizations.

хроническая сердечная недостаточность, фибрилляция предсердий, chronic heart failure, atrial fibrillation, heart rate control

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