Potential Risk Factors In Patients With Heart Failure And Atrial Fibrillation

Objectives:Heart failure(HF)is the final stage of various cardiovascular diseases,and its incidence continues to increase.There are 64 million patients with HF in the world.Atrial fibrillation(AF)is the most common tachyarrhythmia,with an estimated 60 million of patients with AF worldwide.Both HF and AF are facing severe challenges in the field of cardiovascular disease,because of their similar risk factors,they often exist and form a vicious circle at the same time,accelerating the progress of the disease and worsening the prognosis.HF is a risk factor for AF,and AF is also a common cause of decompensation of HF.The prevalence rate of HF and AF is rising,which has caused a huge medical burden to the society.Uric acid is the end product of purine metabolism in human body,which can cause a series of cardiovascular physiological effects.Thus hyperuricemia can lead to AF,HF,hypertension and other cardiovascular diseases.Therefore,as an easily available clinical index,serum uric acid is of great research value in patients with HF and AF.At the same time,accurate evaluation of cardiac systolic function is also very important for HF and AF,which is directly related to the formulation and selection of treatment strategies and plans for patients.At present,left ventricular ejection fraction(LVEF)is mainly used as an important index to evaluate cardiac systolic function.However,due to the absolute arrhythmia and rapid ventricular rate during the attack of AF,it is difficult to ensure the accuracy and repeatability of echocardiography in measuring the ejection fraction of patients with HF and AF.Therefore,based on clinical practice,the purpose of this study is to study the potential factors affecting the clinical prognosis of patients with HF and AF,and to explore the effect and difference of AF on ejection fraction in patients with HF,so as to provide reference for clinical diagnosis and treatment of patients with HF and AF.Methods:This study is an observational study in real world.746 patients with HF and AF were selected and 305 patients with HF and AF were included.All patients were enrolled in the study between January 2019 and October 2020.The follow-up period was defined as patient enrollment to March 2021.The demographic data,personal history,past medical history,medication history,clinical symptoms and signs,laboratory biochemical indexes,electrocardiogram and echocardiography data were recorded.Cox risk ratio model was used to calculate the risk ratio of readmission factors in patients with HF and AF.Kaplan-Meier survival curve was used to express the readmission rate without cardiovascular events in patients with HF and AF.Results:Among the 305 patients with HF and AF,147 were males(48.2%)and 158 were females(51.8%).The average age of males was 72.6 years and that of females was 75.8years(p=0.028).With the increase of NYHA grade,the incidence of hyperuricemia in patients with HF and AF increased gradually,and the difference was statistically significant(p=0.004).68.7% of the male patients were re-admitted because of HF,and 67.1% of the female patients were re-admitted because of HF,p=0.716.The results also showed that there was a difference in LVEF between male and female patients,which was 48.70% ±13.37% in males and 54.40% ±10.50% in females(p<0.001).The left ventricular end-systolic diameter,left ventricular end-diastolic diameter and right ventricular diameter of female patients were lower than those of male patients(p<0.05).By analyzing the cardiac color Doppler parameters of 75 patients with HF and AF during sinus rhythm and atrial fibrillation rhythm,only the difference of left ventricular end-diastolic diameter was found to be statistically significant(p<0.001).The results of Cox proportional hazard model showed that the risk of re-admission due to cardiovascular events was associated with hyperuricemia(HR: 1.932,95%CI: 1.397～2.670,p<0.001),heart rate(HR: 1.015,95%CI: 1.008～1.022,p<0.001),left ventricular end-diastolic diameter(HR: 1.019,95%CI: 1.006～1.033,p=0.005),the use of beta blockers(HR: 0.700,95%CI: 0.516～0.950,p=0.022)and catheter ablation related(HR:0.625,95%CI: 0.406～0.960,p=0.032)in patients with HF and AF.Kaplan-Meier curve revealed that there was a difference in the distribution of "survival" between patients with hyperuricemia and patients without hyperuricemia(p<0.001).Conclusion:With the increase of NYHA grade in patients with HF and AF,the incidence of hyperuricemia increases gradually.Hyperuricemia was a risk factor for HF re-admission in patients with HF and AF.Hyperuricemia could predict HF re-admission events in patients with HF and AF.There were significant gender differences in LVEF,left ventricular enddiastolic diameter,left ventricular end-systolic diameter and right ventricular diameter in patients with HF and AF,suggesting that female patients were more likely to show HFp EF with AF.And there was no difference in LVEF between sinus rhythm and atrial fibrillation rhythm.