Acute heart failure and atrial fibrillation: Insights from the acute study of clinical effectiveness of nesiritide in decompensated heart failure (ASCEND-HF) trial

Background--patients with acute heart failure (ahf) frequently have atrial fibrillation (af),but how this affects patient-reported outcomes has not been well characterized. methods and results--we examined dyspnea improvement and clinical outcomes in 7007 patients in the acute study of clinical effectiveness of nesiritide in decompensated heart failure (ascend-hf) trial. at baseline,2677 (38.2%) patients had current or a history of af and 4330 (61.8%) did not. patients with a history of af were older than those without (72 vs. 63 years) and had more comorbidities and a higher median left ventricular ejection fraction (31% vs. 27%,p<0.001). compared to those without af,patients with af had a similar mean ventricular rate on admission (81 vs. 83 beats per minute [bpm]; p=0.138) but a lower rate at discharge (75 vs. 78 bpm; p<0.001). there was no difference in dyspnea improvement between patients with and without af at 6 hours (p=0.087),but patients with af had less dyspnea improvement at 24 hours (p<0.001). compared to patients without af,patients with af had a higher 30-day all-cause mortality rate (4.7% vs. 3.3%; p=0.005),a higher 30-day hf rehospitalisation rate (7.2% vs. 5.3%; p=0.001),and a higher coprimary composite outcome of 30-day death or readmission (11.6% vs. 8.6%; p<0.001). this difference persisted after adjustment for prognostic variables (adjusted odds ratio=1.19; (95% confidence interval,1.02 to 1.38; p=0.029). conclusions--among patients admitted to the hospital with ahf,current or a history of af is associated with less dyspnea improvement and higher morbidity and mortality at 30-days,compared to those not in af.