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Incidence, predictors and mortality risk of new heart failure in patients hospitalised with atrial fibrillation
  1. Courtney Weber1,
  2. Joseph Hung2,
  3. Siobhan Hickling1,
  4. Lee Nedkoff1,
  5. Kevin Murray1,
  6. Ian Li1,
  7. Tom G Briffa1
  1. 1School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
  2. 2Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
  1. Correspondence to Courtney Weber, School of Population and Global Health, The University of Western Australia, Perth, WA 6009, Australia;{at}


Objective To determine the incidence, risk predictors and relative mortality risk of incident heart failure (HF) in patients following atrial fibrillation (AF) hospitalisation.

Methods The Western Australian Hospitalisation Morbidity Data Collection was used to identify patients aged 25–94 years with index (first-in-period) AF hospitalisation, but without a prior HF admission, between 2000 and 2013. We evaluated the risk of incident HF hospitalisation within 3 years after AF admission, and the impact of HF hospitalisation on all-cause mortality.

Results The cohort comprised 52 447 patients, 57.5% men, with a median age of 73.1 (IQR 63.2-80.8) years. At 3 years after AF discharge, the cumulative incidence of HF (n=6153) was 11.7% (95% CI 11.5% to 12.0%) and all-cause death (n=9702) was 18.5% (95% CI 18.2% to 18.8%). Independent predictors of incident HF included advancing age, any history of myocardial infarction (MI), peripheral vascular disease, valvular heart disease, chronic kidney disease, chronic obstructive pulmonary disease, hypertension, diabetes, obesity and excessive alcohol use (all p<0.001). Patients hospitalised for first-ever HF compared with those without HF hospitalisation had an adjusted HR of 3.3 (95% CI 3.1 to 3.4) for all-cause mortality (p<0.001). Independent predictors of HF were also shared with those for mortality, with the exception of hypertension.

Conclusion Hospitalisation for new HF is common in patients with AF and independently associated with a 3-fold hazard for death. The clinical predictors of incident HF emphasise the importance of integrated management of common comorbid conditions and lifestyle risk factors in patients with AF to reduce their morbidity and mortality.

  • atrial fibrillation
  • heart failure
  • epidemiology

Statistics from


  • Contributors CW, JH, SH, IL and TGB conceived the study. CW, JH and TGB contributed to the study design and methods. CW performed the data and statistical analyses with statistical advice from KM. CW drafted the manuscript. CW, JH, SH, LN, KM, IL and TGB interpreted the results, provided critical review and approved the manuscript for submission.

  • Funding CW is currently a PhD student with the UWA School of Population and Global Health, and is the recipient of a postgraduate scholarship from the National Health and Medical Research Council of Australia (NHMRC) Centre of Research Excellence in Cardiovascular Outcomes Improvement (# 1111170). LN is supported by an NHMRC Early Career Fellowship.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval was obtained from the WA Department of Health, Human Research Ethics Committee (ethics number: 2014/55 date: 05/09/2016). The study adhered to the requirements of the Privacy Act 1988, the National Statement on ethical conduct in Human Research and the ethical guidelines of the 1975 Declaration of Helsinki.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data may be obtained from a third party and are not publicly available. We will consider requests for data sharing on an individual basis, with the aim to share data whenever possible for appropriate research purposes. However, this research project uses data obtained from a third-party source under strict privacy and confidentiality agreements from the Western Australian Department of Health databases, which are governed by their ethics committee and data custodians. The data were provided after approval was granted from their standard application processes for access to the linked datasets. Therefore, any requests to share these data with other researchers will be subject to formal approval from the third-party ethics committees and data custodians. Researchers interested in these data should contact the Client Services Team at the Data Linkage Branch of the Western Australian Department of Health (

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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