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ESC Congress 2026 Abstract

Heart failure before irregular heartbeat linked to higher death risk

Patients who developed heart failure before atrial fibrillation had an adjusted hazard ratio of 1.180 for five-year death compared with those with atrial fibrillation first.

Paper by C Wang, Amir Askarinejad, L Serio, 6 more authorsGregory Y H Lip · First Affiliated Hospital of Henan University of Science and Technology
A cutaway heart with an enlarged chamber sits beside a smaller heart, with fragmented kidney tissue nearby contrasting with an intact kidney.
Cohort study of patients with both HF and non-valvular AF, five yearsPopulations

222,938 participants, 5 years

Edited by Boris Djordjevic · AgingResearch.News

Paper
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An observational study analyzed health records from 111,254 patients with an average age of 72.9 years who developed heart failure before non-valvular atrial fibrillation, an irregular heartbeat, and 222,938 patients with an average age of 75.8 years who developed atrial fibrillation first. Researchers required at least one month between the two diagnoses. Before matching, females made up 42.5% of the heart failure first group and 57.3% of the atrial fibrillation first group.

After matching for demographics and major illnesses, developing heart failure first was associated with higher five-year risks of all-cause death, major adverse cardiovascular events, and major adverse kidney events. The adjusted hazard ratio for death was 1.180. For overall dementia, the range of likely values included no difference. These risk differences appeared attenuated among users of direct oral anticoagulants, but more pronounced among users of vitamin K antagonists.

Why it matters

Heart failure and atrial fibrillation frequently co-occur in older adults, but doctors know little about how the timing of their onset influences broader organ health. Understanding these disease sequences could help clinicians better identify which older patients face greater risks across multiple organ systems and tailor medication choices accordingly.

Caveats

Because this was an observational analysis of electronic health records, it cannot determine cause and effect. The results also apply only to patients diagnosed with both heart failure and non-valvular atrial fibrillation at least one month apart, not to people with heart valve disease or those diagnosed with both conditions concurrently.

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