Heart failure ‘most common’ complication of atrial fibrillation

They found that the lifetime risk of developing AF – irregular and often abnormally fast heart rate heart rhythm – has increased from one in four to one in three over the last 20 years.

“Although AF guidelines principally focus on stroke prevention, our findings indicate that heart failure was the major complication”

Study authors

Among those with the condition, two in five were found to be likely to develop heart failure over their remaining lifetime and one in five a stroke.

Researchers noted that in the NHS in England alone, more new cases of AF were diagnosed each year than the four most common causes of cancer combined.

They highlighted that once AF develops, traditionally patient care has primarily focused on the risk of stroke, while other cardiovascular complications had not previously been fully explored.

As a result, researchers analysed national data for 3.5 million Danish adults with no history of AF at the age of 45 or older to see whether they developed it over a 23-year-period, from 2000-2022.

All 362,721 of the individuals with a new diagnosis of AF during this time, but with no complications, were subsequently followed up until they had a diagnosis of heart failure, stroke or heart attack.

Factors such as history of hypertension, diabetes, high cholesterol, heart failure, chronic lung and kidney disease, family income and educational attainment, were also taken into account.

The study authors said the results showed that the lifetime risk of AF increased from 24% in 2000-2010 to 31% in 2011-2022.

The increase was larger among men and individuals with a history of heart failure, heart attack, stroke, diabetes, and chronic kidney disease, they said in the British Medical Journal.

Among those with AF, the most common complication was found to be heart failure, with a lifetime risk of 41%, according to the study led by Aalborg University.

This was twice as large as the lifetime risk of any stroke (21%) and four times greater than the lifetime risk of heart attack (12%), noted the researchers.

Men showed a higher lifetime risk of complications after AF compared with women for heart failure (44% versus 33%) and heart attack (12% versus 10%).

Meanwhile, the lifetime risk of stroke after AF was slightly lower in men than women (21% versus 23%), said the researchers.

Over the 23-year study period, there was virtually no improvement in the lifetime risk of heart failure after AF and only slight decreases in that of any stroke, ischaemic stroke, and heart attack after AF.

The authors said: “Our nationwide study shows that the lifetime risk of atrial fibrillation increased over the past two decades from one in four to one in three.

“Although AF guidelines principally focus on stroke prevention, our findings indicate that heart failure was the major complication after incident AF,” stated the researchers in the BMJ.

“After AF, heart failure was the most frequent complication, with a lifetime risk of two in five, twice greater than the lifetime risk of stroke after AF,” they said.

They added: “Our novel quantification of the long-term downstream consequences of AF highlights the critical need for treatments to further decrease stroke risk as well as for heart failure prevention strategies among patients with AF.”

The study was funded by the Danish Cardiovascular Academy, which in turn is funded by the Novo Nordisk Foundation and the Danish Heart Foundation.