Background: Atrial fibrillation (AF) and heart failure (HF) each contributes to global disease burden and can coexist. The interplay of prior HF, prior AF, and presenting rhythm have not previously been jointly considered in prognostic implication.

Objective: We sought to assess one-year all-cause mortality, according to permutations of prior HF, prior AF, and AF as presenting rhythm, in a global cohort of patients hospitalized for HF.

Methods: The REPORT-HF registry enrolled patients during hospitalization for acute HF from 44 countries over 6 continents. Cox proportional hazards models were used to compute hazard ratios (HRs) for primary outcome of one-year all-cause mortality.

Results: Of 13,401 participants (age 67 years, 61% men), 58% had prior HF. AF prevalence (prior or newly-detected) at HF admission was 39%, varying by LVEF and race subgroups. Compared to patients with no prior HF, no prior AF and presenting in sinus rhythm, one-year all-cause mortality was elevated in patients with prior HF, prior AF and presenting in AF (adjusted HR 1.54, 95% CI 1.34-1.78, p <0.001) and in patients with prior HF, no prior AF, presenting in AF (adjusted HR 1.51, CI 1.20-1.90, p <0.001) but not in patients with no prior HF with prior AF or presenting in AF; these were conserved across LVEF and race subgroups.

Conclusions: In a global cohort of patient hospitalized for HF, permutations of prior HF, prior AF, and AF as presenting rhythm differentiate outcome. History of prior HF influences the prognostic implications of AF in patients hospitalized for HF.

Editors

JACC Heart Failure Editor-in-Chief
Biykem Bozkurt, MD, PhD, FACC 

Deputy Editor
Akshay S. Desai, MD, MPH 

JACC Heart Failure CME/MOC Editor
Kenneth A. Ellenbogen, MD

Author
Ioannis Dimarakis, MD, PhD

Important Dates

Date of Release: March 3, 2025
Term of Approval/Date of CME/MOC Expiration: March 2, 2026