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Background: A novel risk scoring system (H2ARDD) for estimating the incidence of heart failure (HF) events in atrial fibrillation (AF) has been developed, which represents points assigned for organic heart disease (2 points), anemia (1 point), renal dysfunction (1 point), diabetes (1 point), and diuretic use (1 point). We aimed to clarify whether H2ARDD score is related to cardiopulmonary exercise testing (CPX) parameters in patients with AF. Methods: The study population included 344 consecutive patients with AF who underwent CPX as initial screening between June 2004 and March 2012. The association between 4 CPX parameters and the incidence of HF events was analyzed by using multiple linear regression models. Results: The peak O2 uptake (peak V̇O2), anaerobic (gas exchange) threshold (AT), and ratio of the increase in V̇O2 to the increase in work rate (ΔV̇O2/ΔWR) were lower and the slope of the increase in ventilation to the increase in CO2 output (V̇E–V̇CO2 slope) was higher in patients with than in those without each H2ARDD score component. Accordingly, the parameters significantly increased or decreased according to H2ARDD score. With the multiple linear regression models, H2ARDD score was independently associated with each CPX parameter even after adjustment for various cofactors. Conclusions: H2ARDD score was independently associated with the well-established CPX parameters in patients with AF, suggesting a potential pathophysiological basis for a risk stratification system for predicting HF events in patients with AF.

Background: Atrial fibrillation (AF) is a common arrhythmia in patients with heart failure (HF); however, its impact on unselected outpatients with HF remains unclear. Methods: We followed 2024 symptomatic outpatients with HF who visited the Cardiovascular Institute Hospital (The Shinken Database: 2004–2011, N=17,517). We examined the prevalence, clinical characteristics, and outcomes of AF in these outpatients with HF. Results: AF was observed in 310 of the patients (15%). Patients with AF were older; more likely to be female; and had lower rates of hypertension, diabetes mellitus, and ischemic heart disease. However, they also had higher rates of New York Heart Association grades III/IV, lower left ventricular ejection fraction (EF), renal dysfunction, and dilated cardiomyopathy. The use of cardiovascular drugs including beta-blockers, renin-angiotensin-system inhibitors, diuretics, digitalis, and antiarrhythmic drugs was more common in patients with AF. Kaplan–Meier curves revealed that the incidences of all-cause death, cardiovascular disease death, and HF-related admission were significantly higher in patients with AF. Kaplan–Meier curves and an unadjusted Cox regression analysis showed that AF was associated with a significantly higher risk of all-cause death, cardiovascular death, and HF-related admission. However, the adjusted Cox regression model showed that AF was no longer an independent risk factor for all-cause death, cardiovascular death, and HF death but remained an independent risk factor of HF-related admission (hazard ratio, 1.781; 95% confidence interval, 1.172–2.704; p=0.007). Conclusions: AF was frequently observed in outpatients with HF. AF was not associated with long-term mortality but was independently associated with HF-related admission in this outpatient population.