IMPACT OF ATRIAL FIBRILLATION ON RENAL FUNCTION IN HEART FAILURE PATIENTS USING REAL WORLD DATA

Objective: The objective of the present study is to assess the nalysedional interaction between heart failure (HF) and atrial fibrillation (AF) in the renal function using Real World Data. Design and method: From an Electronic Health Recording with a population of 3,799,885 adult subjects, those with prevalent or incident HF were selected and followed throughout a study period of 5 years. Prevalence and incidence of AF, and their impact in worsening renal function (decrease eGFR> 20%), were identified. When both eGFR and albuminuria data was available, the patients were classified on the Kidney Disease Global Outcomes (KDIGO) risk scale. Two different sets of data were nalysed in two groups of HF patients: S1) included all patients with prevalent or incident HF, 128086 patients; S2) included subjects with a new diagnosis of HF during the study period in the absence of previous AF, 57354 patients. Results: In S1, the impact of AF on a reduction of eGFR by > 20% was observed in 18,513 patients, incidence 66.2/103 patients/year, Figure panel A with an increment of risk (HR 1.13, P95th CI 1.09–1.18, p < 0.001) higher than the present due to diabetes, hypertension, dyslipidemia or coronary heart disease. The increment of risk was also demonstrated in S2, Figure panel B. The number of subjects with decreased eGFR values was 7,067, incidence 94.0/103 patients/year with AF increasing the risk (HR 1.22, P95th CI 1.14–1.31, p < 0.001) independent of the other potential factors. In the subgroup of patients with KDIGO risk classification, 10,425 (27.8%) and 3,297 (23.2%) respectively in S1 and S2 cohorts increased by at least one category in S1 and S2, respectively. Conclusions: AF largely increases the risk of decline renal function contributing to the deterioration in the condition of these patients.