Heart failure in patients with recently diagnosed atrial fibrillation: findings from the GLORIA-AF Registry Phase III

Aims: Congestive heart failure (CHF) is often coexisting in patients with atrial fibrillation (AF), but the clinical epidemiology of this association is still uncertain. We aimed to analyse characteristics, management, and outcomes of patients with and without CHF, in a real-world cohort of patients with AF. Methods and results: From the GLORIA-AF Registry Phase III, which enrolled adults with a recent diagnosis of AF and a CHA2DS2-VASc ≥ 1, we analysed factors associated with CHF at baseline, the association of CHF with use of oral anticoagulants (OAC) and other treatments, and the risk of adverse outcomes during a 3-year follow-up. The primary outcome was a composite of all-cause death and major adverse cardiovascular events (MACE). Among 21,125 patients included (mean age: 70.2 ± 10.3 years, 44.9% females), 4632 (21.9%) had CHF. Patients with CHF and left ventricular ejection fraction (LVEF) ≤ 40% had higher odds of receiving OAC [odds ratio 1.47, 95% confidence interval (CI): 1.27-1.71], while no significant differences were found for CHF with LVEF > 40%. Compared with vitamin K antagonist, non-vitamin K oral anticoagulants were less used in patients with CHF, irrespective of LVEF. On multivariable Cox regression analysis, CHF was associated with an increased hazard of the primary outcome (hazard ratio: 2.04, 95% CI: 1.87-2.23). Similar results were observed for other secondary outcomes, including thromboembolism and major bleeding. Risk increases were higher in patients with LVEF ≤ 40%. Conclusion: Congestive heart failure is common in real-world patients with AF and is associated with a more complex clinical phenotype, different management, and worse prognosis. Additional interventions are needed to improve prognosis of AF-CHF patients.