Kidney function and the risk of heart failure in patients with new-onset atrial fibrillation

Int J Cardiol. 2020 Dec 1;320:101-105. doi: 10.1016/j.ijcard.2020.08.003. Epub 2020 Aug 6.

Abstract

Aims: Heart failure (HF) is the most common complication of patients with atrial fibrillation (AF), but possible risk factors or health consequences are not well described. Low kidney function is a risk factor for both AF and HF. We evaluated estimated glomerular filtration rate (eGFR) as a predictor of HF in patients with AF, and then quantified the adverse health outcomes associated to incident HF.

Methods and results: This is an observational analysis of 19,662 adults without a previous history of HF who had new-onset AF in Stockholm healthcare (Sweden) during 2007-2011. During a median of 713 (IQR 281-1253) days of follow up, 3342 (16.4%) patients developed HF, with incidence rate of 7.4 per 100-person-years (95% CI 7.2-7.7). In Cox regression, eGFR was linearly associated with subsequent HF risk. Compared to eGFR≥60 ml/min/1.73 m2, patients with eGFR 30-59 and eGFR<30 ml/min/1.73 m2 had 13% (HR 1.13; 95% CI 1.04-1.23) and 53% (HR 1.53; 1.25-1.88) higher risk of HF. Results were consistent across various pre-specified subgroups and after excluding early events. Compared to non-HF, developing HF (as a time-varying exposure) was associated with a 5-fold (HR 5.05; 4.07-6.28) higher risk of subsequent kidney function decline, a 1.5 times higher risk of stroke (HR 1.54; 1.35-1.76), and a doubling in the risk of myocardial infarction (HR 2.21; 1.87-2.62) and death (HR 2.17; 2.01-2.33).

Conclusion: In patients with AF, low kidney function associates with the risk of HF. Developing HF heightened the subsequent risk of kidney function decline, cardiovascular event and death.

Keywords: Atrial fibrillation; Heart failure; Kidney function; Outcomes.