AHF With AFib Presentation in ED Associated With Worse MACE Outcomes

Colored chest X-ray (front view) of a patient aged 47, showing an enlarged heart (cardiomegaly, pink, center left and center right). This disease has caused heart failure (cardiac insufficiency) in which the heart cannot supply enough blood to the body.
Study investigators assessed the impact of acute heart failure on long-term adverse outcomes among patients who present to the emergency department with atrial fibrillation.

The coexistence of acute heart failure (AHF) in patients presenting to the emergency department (ED) with atrial fibrillation is associated with worse 1-year outcomes, primarily due to major cardiovascular events (MACEs), according to findings published in the European Journal of Emergency Medicine. However, researchers indicated this does not impact overall mortality.

According to researchers, there is not much evidence regarding the impact of AHF on the prognosis of patients presenting to the ED with atrial fibrillation. Study investigators designed this secondary analysis of a prospective, observational, multicenter, cohort of consecutive atrial fibrillation patients to assess the impact of AHF on long-term adverse outcomes among patients who present to the ED with atrial fibrillation.

Of the 1107 consecutive ED patients with atrial fibrillation analyzed, 262 (23.7%) were also diagnosed with acute heart failure. The primary outcome was the combination of 1-year all-cause mortality, stroke, major bleeding, stroke, and other MACEs. Secondary outcomes for each of these events were analyzed separately. Significant associations between AHF and outcomes, adjusted, were investigated using Cox and logistic regression.

Of the 1107 total participants included in the final analysis, 648 (58.5%) experienced atrial fibrillation as the main complaint. During the 12-month follow-up, the primary outcome occurred in 39.1% of participants (n=433/1107), and AHF was independently associated with the primary outcome (adjusted odds ratio [aOR], 1.417; 95% CI, 1.018-1.972; P =.040). One-year all-cause mortality occurred in 151 participants (13.6%), major bleeding in 47 participants (4.2 %), stroke in 31 participants (2.8 %), and other MACEs in 333 participants (30.1%).

AHF was independently related to 1-year MACEs (OR, 1.804; 95% CI, 1.290-2.524; P =.001), but not to 1-year all-cause mortality (OR, 0.920; 95% CI, 0.629-1.345; P =.666), bleeding (OR, 0.563; 95% CI, 0.261-1.212; P =.146), or stroke (OR, 1.441; 95% CI, 0.569-3.651; P =.443).

Study investigators concluded that this study is the largest to analyze AHF’s impact “on long-term mortality in patients with atrial fibrillation treated in the EDs and shows that the coexistence of AHF is associated with a higher risk of developing 1-year cardiovascular events, although it does not have an impact on the 1-year mortality. Further studies concerning the impact of quality of life and costs of [these] cardiovascular events are warranted to help determine if specific interventions should be made in patients with AHF and atrial fibrillation to improve the quality of management in the acute setting.”

Disclosure: This clinical trial was supported by Bayer Hispania. Please see the original reference for a full list of authors’ disclosures.


Coll-Vinent B, Varona M, Martin A, et al; on behalf of the EMERG-AF investigators. Association between acute heart failure and major cardiovascular events in atrial fibrillation patients presenting at the emergency department: an EMERG-AF ancillary study. Eur J Emerg Med. Published online June 1, 2021. doi:10.1097/MEJ.0000000000000779