Atrial fibrillation in chronic heart failure: prevalence and one-year outcome in the Ibadan chronic heart failure project.

BACKGROUND

Atrial fibrillation (AF) and heart failure (HF) frequently coexist, with each condition exacerbating the other through complex haemodynamic and structural interactions. While the prognostic influence of AF in HF is well-established in high-income settings, data from sub-Saharan Africa remain scarce. The objective of the study is to examine the prevalence, clinical correlates, and one-year outcomes associated with AF among Nigerian patients with chronic HF.

METHODS

This was a pragmatic, real-life, prospective observational cohort study. It was conducted at the Cardiology Unit of the Department of Medicine of the University College Hospital, Ibadan, Nigeria, which is a tertiary hospital. A total of 1040 adults with clinically and echocardiographically confirmed chronic HF were enrolled. The participants were followed up for 12 months. The primary outcome was all-cause mortality, while the secondary outcomes were hospital admissions and a composite of deaths and admissions.

RESULTS

Atrial fibrillation (AF) was present in 136 patients (13.1%) at baseline. Patients with AF were significantly older than those without AF (63.8 ± 14.2 vs. 55.7 ± 15.7 years, P < 0.001) and had lower mean systolic blood pressure (114.9 ± 22.2 vs. 121.2 ± 24.5 mmHg, P = 0.007). The distribution of heart failure subtypes by left ventricular ejection fraction did not differ significantly between AF and non-AF groups (HFrEF 39.7% vs. 42.4%, HFmrEF 31.0% vs. 26.8%, HFpEF 29.3% vs. 30.7%, P = 0.811). Mitral and tricuspid regurgitation were more prevalent among patients with AF. At one-year follow-up, mortality was higher among patients with AF (22.8%vs. 17.7%), but this was not statistically significant (p = 0.20). Rehospitalisation occurred in 5.1% of patients with AF compared with 4.2% of those in sinus rhythm (p = 0.881).

CONCLUSIONS

AF affected roughly one in eight Nigerian patients with CHF and was linked to older age, lower blood pressure, and greater valvular dysfunction. Although AF was not an independent predictor of the composite outcome, patients with AF exhibited numerically higher event rates.