Objective Heart failure (HF) often coexists in atrial fibrillation (AF) but is frequently unrecognised due to overlapping symptomatology. Furthermore, AF can cause elevated natriuretic peptide levels, impairing its diagnostic value for HF detection. We aimed to assess the prevalence of previously unknown HF in community-dwelling patients with AF, and to determine the diagnostic value of the amino-terminal pro B-type natriuretic peptide (NTproBNP) for HF screening in patients with AF.
Methods Individual participant data from four HF-screening studies in older community-dwelling persons were combined. Presence or absence of HF was in each study established by an expert panel following the criteria of the European Society of Cardiology. We performed a two-stage patient-level meta-analysis to calculate traditional diagnostic indices.
Results Of the 1941 individuals included in the four studies, 196 (10.1%) had AF at baseline. HF was uncovered in 83 (43%) of these 196 patients with AF, versus 381 (19.7%) in those without AF at baseline. Median NTproBNP levels of patients with AF with and without HF were 744 pg/mL and 211 pg/mL, respectively. At the cut-point of 125 pg/mL, sensitivity was 93%, specificity 35%, and positive and negative predictive values 51% and 86%, respectively. Only 23% of all patients with AF had an NTproBNP level below the 125 pg/mL cut-point, with still a 13% prevalence of HF in this group.
Conclusions With a prevalence of nearly 50%, unrecognised HF is common among community-dwelling patients with AF. Given the high prior change, natriuretic peptides are diagnostically not helpful, and straightforward echocardiography seems to be the preferred strategy for HF screening in patients with AF.
- atrial fibrillation
- heart failure
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Contributors SD performed data analysis and wrote the first manuscript draft. G-JG interpreted the data and critically revised the manuscript. RFK performed data harmonisation. YvM, LCB, EESvR, LJB-dW performed data collection. KGMM and AWH interpreted the data. FHR coordinated the study. All authors critically revised the manuscript and approved of the final version being submitted.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests G-JG is supported by a VENI grant from The Netherlands Organization for Scientific Research (ZONMW 016.166.030).
Patient consent Obtained.
Ethics approval Medical Ethics Committee of the University Medical Center Utrecht, the Netherlands.
Provenance and peer review Not commissioned; externally peer reviewed.
Correction notice Since this article was first published online, the author surname Booman-de Winter has been updated to Boonman-de Winter.