{
  "abstract": "Introduction Heart failure (HF) and atrial fibrillation (AF) share risk factors, commonly co-exist and incur poorer outcomes in combination. In HF, altered left atrial (LA) loading conditions engender remodelling. Conversely, AF precipitates HF via loss of atrial systole and tachycardia-mediated-cardiomyopathy. HF subtype influences AF development. We aimed to identify predictors of AF in HF subtypes to provide impetus to treat substrates, identify screening targets and illuminate pathophysiology.Methods This retrospective, case-control study examines three groups: HFrEF; HFpEF and pre-clinical (StagesA&B) HF. Cases were defined by DOAC prescription during follow-up. Controls were age and sex matched. Data was collected on pre-specified variables at ‘baseline’ (enrolment) and ‘follow-up’ (closest measurement preceding DOAC initiation). Statistically/clinically relevant variables were included in uni/multivariate regressions.Results 171 pre-clinical HF, 318 HFpEF and 467 HFrEF cases were included. Pertinent predictors common to all groups were HTN and baseline LA diameter. Both had strongest predictive value in pre-clinical HF. δBNP was predictive in HFpEF and even more so in pre-clinical HF (47% ↑risk per 50pg/mL). SGLT2i prescription conferred 89% reduction in AF occurrence in HFrEF, while a numerical trend towards protection was seen in HFpEF. BMI heightened AF risk in HFrEF. Another trend toward δLA diameter predicting AF in HFrEF was observed.Discussion The results highlight common and differential predictors of AF across the HF spectrum. HTN’s significance in all subgroups echoes the SPRINT trial’s message. While baseline LA dilatation was predictive of AF in all subgroups, worsening LA dilatation was predictive of AF in HFrEF alone, supporting the notion of eccentric remodelling being a prominent feature of HFrEF atrial myopathy. Our data indicate an anti-arrhythmic effect of SGLT2i, meriting investigation. This study provides insight into HF environments that generate AF, emphasises targets for risk factor modification and suggests a role for BNP in targeted screening.",
  "authors": [
    {
      "affiliations": [
        "St. Vincent’s University Hospital, Dublin, Ireland"
      ],
      "name": "C Powell"
    },
    {
      "affiliations": [
        "St. Vincent’s University Hospital, Dublin, Ireland"
      ],
      "name": "E Saghie"
    },
    {
      "affiliations": [
        "St. Vincent’s University Hospital, Dublin, Ireland"
      ],
      "name": "G Bruno"
    },
    {
      "affiliations": [
        "University College Dublin, Dublin, Ireland"
      ],
      "name": "J Gallagher"
    },
    {
      "affiliations": [
        "University College Dublin, Dublin, Ireland"
      ],
      "name": "M Ledwidge"
    },
    {
      "affiliations": [
        "St. Vincent’s University Hospital, Dublin, Ireland"
      ],
      "name": "M Barrett"
    },
    {
      "affiliations": [
        "St. Vincent’s University Hospital, Dublin, Ireland"
      ],
      "name": "K McDonald"
    },
    {
      "affiliations": [
        "St. Vincent’s University Hospital, Dublin, Ireland"
      ],
      "name": "D Keane"
    }
  ],
  "title": "52 Predictors of atrial fibrillation across the heart failure spectrum",
  "uid": "a0308478-33fd-585c-bb0d-e412daaca3c3"
}