Association of heart failure subtypes and atrial fibrillation: Data from the Atherosclerosis Risk in Communities (ARIC) study.

To determine the prevalence and incidence of AF among HF subtypes in a biracial community-based cohort. We studied 6496 participants in the Atherosclerosis Risk in Community study (mean age, 75.8 ± 5.3, 59% women, 23% black) who attended the 2011–2013 visit. HF was identified from physician adjudicated diagnosis, hospital discharges, and self-report. HF subtypes were based on echocardiography. A left ventricular ejection fraction <40% represents HF with reduced ejection fraction (HFrEF), 40%–49% for HF with midrange ejection fraction (HFmEF), and ≥ 50% for HF with preserved ejection fraction (HFpEF). AF was ascertained through 2017 from study electrocardiograms, hospital discharges, and death certificates. Confounder-adjusted logistic regression and Cox models were used to estimate associations of HF subtype with prevalent and incident AF. Among eligible participants, 393 had HF (HFpEF = 232, HFmEF = 41, HFrEF = 35 and unclassified HF = 85) and 735 had AF. Compared to those without HF, all HF subtypes were more likely to have prevalent AF [odds ratio (95% confidence interval (CI)) 7.4 (5.6–9.9) for HFpEF, 8.1 (4.3–15.3) for HFmEF, 10.0 (5.0–20.2) for HFrEF, 8.8 (5.6–14.0) for unclassified HF]. Among participants without AF at baseline (n = 5761), 610 of them developed AF. Prevalent HF was associated with increased risk of AF [hazard ratio (95%CI) 2.3 (1.6–3.2) for HFpEF, 5.0 (2.7–9.3) for HFmEF, 3.5 (1.7–7.6) for HFrEF, 1.9 (0.9–3.7) for unclassified HF]. AF and HF frequently co-occur, with small differences by HF subtype, underscoring the importance of understanding the interplay of these two epidemics and evaluating shared preventive and therapeutic strategies. • The association of heart failure (HF) subtypes with atrial fibrillation (AF) risk in the community is unclear. • Prevalence of AF was 7-10 times higher and AF rates were 2-5 times higher across HF subtypes compared to no HF. • Prevalence and incidence of AF was highest among individuals with HF with reduced ejection (HFrEF) fraction. Risk of AF in HF with midrange EF was more comparable to HFrEF than HF with preserved EF. [ABSTRACT FROM AUTHOR]