Analysis of clinical characteristics and readmission risk factors in patients with ejection fraction preserved heart failure combined with atrial fibrillation

doi:10.3969/j.issn.1004-583X.2023.04.003

Abstract

Abstract:

Objective To investigate the clinical characteristics and readmission risk factors of patients with ejection fraction preserved heart failure (HFpEF) and atrial fibrillation (AF). Methods The clinical data of 459 patients with HFpEF hospitalized at the Hebei General Hospital from June 2018 to May 2020 were retrospectively analyzed, and they were allocated to AF group (n=242) and sinus rhythm (SR) group (n=217) based on the presence or absence of AF during hospitalization. The clinical data of the two groups were compared, the clinical characteristics of patients with HFpEF and AF were analyzed; further, the readmission risk factors were discussed. Results Compared with those of the SR group, patients in the AF group presented significantly older age, lower proportion of smokers, body mass index (BMI), systolic blood pressure (SBP), proportion of comorbidities of hyperlipidemia and ischemic cardiomyopathy, and proportion of using neprilysin inhibitors, calcium antagonists and antiplatelet drugs, andhigher proportion of comorbidities of somatization disorder and heart valve disease, left ventricular end-systolic diameter, pulmonary artery systolic pressure, B-type natriuretic peptide, left and right atrium diameter, right ventricular diameter, and proportion of using anticoagulant and digitalis(all P<0.05). Univariate and multivariate logistic regression analysis showed that somatization disorder, type 2 diabetes, hyperuricemia, β-blockers were independent risk factors for readmission in patients with HFpEF and AF. Conclusion There were significant differences in clinical profiles between HFpEF patients with and without AF. The comorbidities such as type 2 diabetes, hyperuricemia, and the somatization disorder may be risk factors for readmission in patients with HFpEF and AF, whereas β-blockers may be an independent protective factor for it.

Key words: heart failure with preserved ejection fraction, atrial fibrillation, clinical features, comorbidities

CLC Number:

R541.6

Wang Zhen, Yang Xiaoyue, Li Shaojie, Wang Xian, Chen Shuxia, Gu Jian. Analysis of clinical characteristics and readmission risk factors in patients with ejection fraction preserved heart failure combined with atrial fibrillation[J]. Clinical Focus, 2023, 38(4): 308-314.

Add to citation manager EndNote|Ris|BibTeX

URL: https://huicui.hebmu.edu.cn/EN/10.3969/j.issn.1004-583X.2023.04.003

https://huicui.hebmu.edu.cn/EN/Y2023/V38/I4/308

Figures/Tables 9

References 30

[1]	Brown LAE, Boos CJ. Atrial fibrillation and heart failure: Factors influencing the choice of oral anticoagulant[J]. Int J Cardiol, 2017, 227: 863-868. doi: S0167-5273(16)32512-8 pmid: 28029411
[2]	Schnabel RB, Yin X, Gona P, et al. 50 year trends in atrial fibrillation prevalence, incidence, risk factors, and mortality in the Framingham Heart Study: A cohort study[J]. Lancet, 2015, 386(9989): 154-162. doi: 10.1016/S0140-6736(14)61774-8 pmid: 25960110
[3]	Nair N. Epidemiology and pathogenesis of heart failure with preserved ejection fraction[J]. Rev Cardiovasc Med, 2020, 21(4): 531-540. doi: 10.31083/j.rcm.2020.04.154 URL
[4]	金雪娟, 周京敏. 心力衰竭与心房颤动共存的流行病学和相关临床研究进展[J]. 临床心血管病杂志, 2019, 35(3): 199-202.
[5]	Kotecha D, Lam CS, Van Veldhuisen DJ, et al. Heart failure with preserved ejection fraction and atrial fibrillation: Vicious twins[J]. J Am Coll Cardiol, 2016, 68(20): 2217-2228. doi: S0735-1097(16)35242-1 pmid: 27855811
[6]	McDonagh TA, Metra M, Adamo M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure[J]. Eur Heart J, 2021, 42(36): 3599-3726. doi: 10.1093/eurheartj/ehab368 pmid: 34447992
[7]	Eapen ZJ, Greiner MA, Fonarow GC, et al. Associations between atrial fibrillation and early outcomes of patients with heart failure and reduced or preserved ejection fraction[J]. Am Heart J, 2014, 167(3): 369-375.e2. doi: 10.1016/j.ahj.2013.12.001 pmid: 24576522
[8]	Solomon SD, Rizkala AR, Gong J, et al. Angiotensin receptor neprilysin inhibition in heart failure with preserved ejection fraction: Rationale and design of the PARAGON-HF trial[J]. JACC Heart Fail, 2017, 5(7): 471-482. doi: 10.1016/j.jchf.2017.04.013 URL
[9]	Son MK, Park JJ, Lim NK, et al. Impact of atrial fibrillation in patients with heart failure and reduced, mid-range or preserved ejection fraction[J]. Heart, 2020, 106(15): 1160-1168. doi: 10.1136/heartjnl-2019-316219 pmid: 32341140
[10]	Patel RB, Vaduganathan M, Shah S J, et al. Atrial fibrillation in heart failure with preserved ejection fraction: Insights into mechanisms and therapeutics[J]. Pharmacol Ther, 2017, 176: 32-39. doi: 10.1016/j.pharmthera.2016.10.019 URL
[11]	Knackstedt C, Gramley F, Schimpf T, et al. Association of echocardiographic atrial size and atrial fibrosis in a sequential model of congestive heart failure and atrial fibrillation[J]. Cardiovasc Pathol, 2008, 17(5): 318-324. doi: 10.1016/j.carpath.2007.12.003 pmid: 18402824
[12]	Tanaka K, Zlochiver S, Vikstrom KL, et al. Spatial distribution of fibrosis governs fibrillation wave dynamics in the posterior left atrium during heart failure[J]. Circ Res, 2007, 101(8): 839-847. pmid: 17704207
[13]	Berg MP, Mulder BA, Klaassen SHC, et al. Heart failure with preserved ejection fraction, atrial fibrillation, and the role of senile amyloidosis[J]. Eur Heart J, 2019, 40(16): 1287-1293. doi: 10.1093/eurheartj/ehz057 pmid: 30753432
[14]	Lam CS, Rienstra M, Tay WT, et al. Atrial fibrillation in heart failure with preserved ejection fraction: Association with exercise capacity, left ventricular filling pressures, natriuretic peptides, and left atrial volume[J]. JACC Heart Fail, 2017, 5(2): 92-98. doi: 10.1016/j.jchf.2016.10.005 URL
[15]	Özlek B, Özlek E, Tekinalp M, et al. Comparison of clinical characteristics of patients with heart failure and preserved ejection fraction with atrial fibrillation versus sinus rhythm: Insights from the APOLLON registry[J]. Turk Kardiyol Dern Ars, 2020, 48(3): 234-245. doi: 10.5543/tkda.2019.77236 pmid: 32281959
[16]	李春芝, 赵鑫, 郭士强, 等. 血浆NT-proBNP和总胆固醇浓度联合预测心脏瓣膜病病人恶性心律失常的价值[J]. 首都医科大学学报, 2017, 38(1): 108-112. doi: 10.3969/j.issn.1006-7795.2017.01.022
[17]	刘玉局. 不同性别躯体化障碍临床对照分析[J]. 中国健康心理学杂志, 2004, 12(6): 411-412.
[18]	Go YY, Sugimoto T, Bulluck H, et al. Age and ejection fraction modify the impact of atrial fibrillation on acute heart failure outcomes[J]. Eur J Heart Fail, 2018, 20(4): 821-822. doi: 10.1002/ejhf.1075 pmid: 29148227
[19]	Shimizu T, Yoshihisa A, Kanno Y, et al. Relationship of hyperuricemia with mortality in heart failure patients with preserved ejection fraction[J]. Am J Physiol Heart Circ Physiol, 2015, 309(7): H1123-1129. doi: 10.1152/ajpheart.00533.2015 URL
[20]	Goette A, Bukowska A, Lillig CH, et al. Oxidative stress and microcirculatory flow abnormalities in the ventricles during atrial fibrillation[J]. Front Physiol, 2012, 3: 236. doi: 10.3389/fphys.2012.00236 pmid: 22783202
[21]	Devidi M, Buddam A, Dacha S, et al. Atrial fibrillation and its association with endocrine disorders[J]. J Atr Fibrillation, 2014, 6(5): 959.
[22]	Veldhuisen DJ, Aass H, Allaf D, et al. Presence and development of atrial fibrillation in chronic heart failure. Experiences from the MERIT-HF Study[J]. Eur J Heart Fail, 2006, 8(5): 539-546. pmid: 16567126
[23]	Alobaida M, Alrumayh A. Rate control strategies for atrial fibrillation[J]. Ann Med, 2021, 53(1): 682-692. doi: 10.1080/07853890.2021.1930137 pmid: 34032538
[24]	钱波. 躯体化障碍与抑郁症的相关性研究[D]. 苏州大学, 2017.
[25]	易斑斓, 段书, 徐好, 等. 三甲医院与基层医院心内科患者情绪障碍及其影响因素研究[J]. 中国临床心理学杂志, 2022, 30(3): 645-649.
[26]	Farhoumandi N, Zarean M, Nasiri M, et al. Somatization mediates the structural relationship of alexithymia with anxiety and depression[J]. Iran J Psychiatry, 2022, 17(2): 144-153. doi: 10.18502/ijps.v17i2.8904 pmid: 36262762
[27]	Haehling S, Arzt M, Doehner W, et al. Improving exercise capacity and quality of life using non-invasive heart failure treatments: Evidence from clinical trials[J]. Eur J Heart Fail, 2021, 23(1): 92-113. doi: 10.1002/ejhf.v23.1 URL
[28]	Su J, Wang J, Ma Y, et al. Inflammation associated with chronic heart failure leads to enhanced susceptibility to depression[J]. Febs J, 2019, 286(14): 2769-2786. doi: 10.1111/febs.14839 pmid: 30963701
[29]	杨荣军, 史钰芳, 王庆海, 等. 慢性心力衰竭与抑郁症共同发病机制及药物治疗的研究进展[J]. 中国全科医学, 2022, 25(5): 625-630.
[30]	Brown L, Karmakar C, Gray R, et al. Heart rate variability alterations in late life depression: A meta-analysis[J]. J Affect Disord, 2018, 235: 456-466. doi: 10.1016/j.jad.2018.04.071 URL

组别	例数	年龄 (岁)	性别[例(%)]		吸烟史 [例(%)]	BMI (kg/m²)	血压(mmHg)		入院心率 (次/min)	NYHA分级[例(%)]
组别	例数	年龄 (岁)	男性	女性	吸烟史 [例(%)]	BMI (kg/m²)	收缩压	舒张压	入院心率 (次/min)	2级	3级	4级
AF组	242	77.0(59.8, 84.0)	109(45.0)	133(55.0)	34(14.0)	23.50(20.28, 26.23)	134(118, 151)	76(66, 86)	80(68, 96)	55(22.7)	116(48.0)	71(29.3)
SR组	217	70.0(62.0, 80.0)	114(52.5)	103(47.5)	52(24.0)	24.20(21.88, 27.68)	142(126, 159)	78(68, 91)	78(68, 90)	52(24.0)	102(47.0)	63(29.0)
统计值		Z=5.242	χ²=2.572		χ²=7.385	Z=-2.912	Z=-3.273	Z=-1.533	Z=1.578	χ²=0.099
P值		0.001	0.109		0.007	0.004	0.001	0.125	0.114	0.169

组别	例数	年龄 (岁)	性别[例(%)]		吸烟史 [例(%)]	BMI (kg/m²)	血压(mmHg)		入院心率 (次/min)	NYHA分级[例(%)]
组别	例数	年龄 (岁)	男性	女性	吸烟史 [例(%)]	BMI (kg/m²)	收缩压	舒张压	入院心率 (次/min)	2级	3级	4级
AF组	242	77.0(59.8, 84.0)	109(45.0)	133(55.0)	34(14.0)	23.50(20.28, 26.23)	134(118, 151)	76(66, 86)	80(68, 96)	55(22.7)	116(48.0)	71(29.3)
SR组	217	70.0(62.0, 80.0)	114(52.5)	103(47.5)	52(24.0)	24.20(21.88, 27.68)	142(126, 159)	78(68, 91)	78(68, 90)	52(24.0)	102(47.0)	63(29.0)
统计值		Z=5.242	χ²=2.572		χ²=7.385	Z=-2.912	Z=-3.273	Z=-1.533	Z=1.578	χ²=0.099
P值		0.001	0.109		0.007	0.004	0.001	0.125	0.114	0.169

组别	例数	高脂血症		高血压		冠状动脉疾病		心脏瓣膜病		缺血性心肌病		脑血管病		慢性阻塞性肺疾病
AF组	242	28(11.6)		165(68.2)		143(59.1)		134(55.4)		16(6.6)		98(40.5)		19(7.9)
SR组	217	41(18.9)		159(73.3)		141(65.0)		60(27.6)		35(16.1)		78(35.9)		15(6.9)
χ²值		4.804		1.428		1.680		36.032		10.493		1.002		0.147
P值		0.028		0.232		0.195		0.001		0.001		0.317		0.701
组别	2型糖尿病		慢性肾病		高尿酸血症		结缔组织病		躯体化障碍		甲状腺功能亢进症		甲状腺功能减退症		颈动脉粥样硬化
AF组	72(29.8)		50(20.7)		58(24.0)		7(2.9)		31(12.8)		8(3.3)		31(12.8)		88(36.4)
SR组	80(36.9)		52(24.0)		39(18.0)		12(5.5)		13(6.0)		2(0.9)		24(11.1)		67(30.9)
χ²值	2.614		0.722		2.467		2.006		6.138		3.051		0.332		1.541
P值	0.106		0.396		0.116		0.157		0.013		0.081		0.564		0.215

组别	例数	高脂血症		高血压		冠状动脉疾病		心脏瓣膜病		缺血性心肌病		脑血管病		慢性阻塞性肺疾病
AF组	242	28(11.6)		165(68.2)		143(59.1)		134(55.4)		16(6.6)		98(40.5)		19(7.9)
SR组	217	41(18.9)		159(73.3)		141(65.0)		60(27.6)		35(16.1)		78(35.9)		15(6.9)
χ²值		4.804		1.428		1.680		36.032		10.493		1.002		0.147
P值		0.028		0.232		0.195		0.001		0.001		0.317		0.701
组别	2型糖尿病		慢性肾病		高尿酸血症		结缔组织病		躯体化障碍		甲状腺功能亢进症		甲状腺功能减退症		颈动脉粥样硬化
AF组	72(29.8)		50(20.7)		58(24.0)		7(2.9)		31(12.8)		8(3.3)		31(12.8)		88(36.4)
SR组	80(36.9)		52(24.0)		39(18.0)		12(5.5)		13(6.0)		2(0.9)		24(11.1)		67(30.9)
χ²值	2.614		0.722		2.467		2.006		6.138		3.051		0.332		1.541
P值	0.106		0.396		0.116		0.157		0.013		0.081		0.564		0.215

组别	例数	LVEF (%)	LVEDD (mm)	LVESD (mm)	LA (mm)	RA (mm)	RV (mm)	PASP (mmHg)	血红蛋白 (g/L)	NT-proBNP (pg/ml)	GFR (ml/min)
AF组	242	59.0(56.0,64.0)	47(44,51)	32(29,36)	46(42,50)	38(33,43)	34(31,39)	48.5(38.0, 60.0)	123(108,134)	2 335.5(1 138.0,4 504.0)	67.91(49.88,4.17)
SR组	217	60.0(56.0,66.0)	48(44,51)	31(29,35)	41(37,45)	33(30,36)	32(29,34)	39.0(31.0, 53.0)	124(102,138)	1 837.0(551.0,4 325.0)	71.44(45.64,88.78)
Z值		0.059	5.112	8.494	8.343	7.812	5.841	4.691	0.056	2.754	0.787
P值		0.808	0.024	0.004	0.001	0.001	0.001	0.001	0.956	0.004	0.291