QRS duration predicts death and hospitalization among patients with atrial fibrillation irrespective of heart failure

Evidence from the AFFIRM study

Matthew G. Whitbeck, Richard J. Charnigo, Jignesh Shah, Gustavo Morales, Steve W. Leung, Brandon Fornwalt, Alison L. Bailey, Khaled Ziada, Vincent L. Sorrell, Milagros M. Zegarra, Jenks Thompson, Neil Aboul Hosn, Charles L. Campbell, John Gurley, Paul Anaya, David C. Booth, Luigi Di Biase, Andrea Natale, Susan Smyth, David J. Moliterno & 1 others Claude S. Elayi

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Aims: The association of QRS duration (QRSd) with morbidity and mortality is understudied in patients with atrial fibrillation (AF). We sought to assess any association of prolonged QRS with increased risk of death or hospitalization among patients with AF. Methods and results: QRS duration was retrieved from the baseline electrocardiograms of patients enroled in the Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) study and divided into three categories: <90, 90-119, <120 ms. Cox models were applied relating the hazards of mortality and hospitalizations to QRSd. Among 3804 patients with AF, 593 died and 2305 were hospitalized. Compared with those with QRS < 90 ms, patients with QRS < 120 ms, had an increased mortality [hazard ratio (HR) 1.61, 95 confidence interval (CI): 1.29-2.03, P < 0.001] and hospitalizations (HR 1.14, 95 CI: 1.07-1.34, P 0.043) over an average follow-up of 3.5 years. Importantly, for patients with QRS 90-119 ms, mortality and hospitalization were also increased (HR 1.31, P 0.005 and 1.11, P 0.026, respectively). In subgroup analysis based on heart failure (HF) status (previously documented or ejection fraction <40), mortality was increased for QRS < 120 ms patients with (HR 1.87, P < 0.001) and without HF (HR 1.63, P 0.02). In the QRS 90-119 ms group, mortality was increased (HR 1.38, P 0.03) for those with HF, but not significantly among those without HF (HR 1.23, P 0.14). Conclusion: Among patients with AF, QRSd < 120 ms was associated with a substantially increased risk for mortality (all-cause, cardiovascular, and arrhythmic) and hospitalization. Interestingly, an increased mortality was also observed among those with QRS 90-119 ms and concomitant HF. All rights reserved.

Original languageEnglish (US)
Pages (from-to)803-811
Number of pages9
JournalEuropace
Volume16
Issue number6
DOIs
StatePublished - 2014
Externally publishedYes

Fingerprint

Atrial Fibrillation
Hospitalization
Heart Failure
Mortality
Confidence Intervals
Proportional Hazards Models
Electrocardiography
Morbidity

Keywords

  • Arrhythmia
  • Atrial fibrillation
  • Bundle branch block
  • Heart failure
  • QRS duration

ASJC Scopus subject areas

  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Cite this

QRS duration predicts death and hospitalization among patients with atrial fibrillation irrespective of heart failure : Evidence from the AFFIRM study. / Whitbeck, Matthew G.; Charnigo, Richard J.; Shah, Jignesh; Morales, Gustavo; Leung, Steve W.; Fornwalt, Brandon; Bailey, Alison L.; Ziada, Khaled; Sorrell, Vincent L.; Zegarra, Milagros M.; Thompson, Jenks; Hosn, Neil Aboul; Campbell, Charles L.; Gurley, John; Anaya, Paul; Booth, David C.; Di Biase, Luigi; Natale, Andrea; Smyth, Susan; Moliterno, David J.; Elayi, Claude S.

In: Europace, Vol. 16, No. 6, 2014, p. 803-811.

Research output: Contribution to journalArticle

Whitbeck, MG, Charnigo, RJ, Shah, J, Morales, G, Leung, SW, Fornwalt, B, Bailey, AL, Ziada, K, Sorrell, VL, Zegarra, MM, Thompson, J, Hosn, NA, Campbell, CL, Gurley, J, Anaya, P, Booth, DC, Di Biase, L, Natale, A, Smyth, S, Moliterno, DJ & Elayi, CS 2014, 'QRS duration predicts death and hospitalization among patients with atrial fibrillation irrespective of heart failure: Evidence from the AFFIRM study', Europace, vol. 16, no. 6, pp. 803-811. https://doi.org/10.1093/europace/eut335
Whitbeck, Matthew G. ; Charnigo, Richard J. ; Shah, Jignesh ; Morales, Gustavo ; Leung, Steve W. ; Fornwalt, Brandon ; Bailey, Alison L. ; Ziada, Khaled ; Sorrell, Vincent L. ; Zegarra, Milagros M. ; Thompson, Jenks ; Hosn, Neil Aboul ; Campbell, Charles L. ; Gurley, John ; Anaya, Paul ; Booth, David C. ; Di Biase, Luigi ; Natale, Andrea ; Smyth, Susan ; Moliterno, David J. ; Elayi, Claude S. / QRS duration predicts death and hospitalization among patients with atrial fibrillation irrespective of heart failure : Evidence from the AFFIRM study. In: Europace. 2014 ; Vol. 16, No. 6. pp. 803-811.
@article{d2763bc8e4484fbb9b1ad5065d58c338,
title = "QRS duration predicts death and hospitalization among patients with atrial fibrillation irrespective of heart failure: Evidence from the AFFIRM study",
abstract = "Aims: The association of QRS duration (QRSd) with morbidity and mortality is understudied in patients with atrial fibrillation (AF). We sought to assess any association of prolonged QRS with increased risk of death or hospitalization among patients with AF. Methods and results: QRS duration was retrieved from the baseline electrocardiograms of patients enroled in the Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) study and divided into three categories: <90, 90-119, <120 ms. Cox models were applied relating the hazards of mortality and hospitalizations to QRSd. Among 3804 patients with AF, 593 died and 2305 were hospitalized. Compared with those with QRS < 90 ms, patients with QRS < 120 ms, had an increased mortality [hazard ratio (HR) 1.61, 95 confidence interval (CI): 1.29-2.03, P < 0.001] and hospitalizations (HR 1.14, 95 CI: 1.07-1.34, P 0.043) over an average follow-up of 3.5 years. Importantly, for patients with QRS 90-119 ms, mortality and hospitalization were also increased (HR 1.31, P 0.005 and 1.11, P 0.026, respectively). In subgroup analysis based on heart failure (HF) status (previously documented or ejection fraction <40), mortality was increased for QRS < 120 ms patients with (HR 1.87, P < 0.001) and without HF (HR 1.63, P 0.02). In the QRS 90-119 ms group, mortality was increased (HR 1.38, P 0.03) for those with HF, but not significantly among those without HF (HR 1.23, P 0.14). Conclusion: Among patients with AF, QRSd < 120 ms was associated with a substantially increased risk for mortality (all-cause, cardiovascular, and arrhythmic) and hospitalization. Interestingly, an increased mortality was also observed among those with QRS 90-119 ms and concomitant HF. All rights reserved.",
keywords = "Arrhythmia, Atrial fibrillation, Bundle branch block, Heart failure, QRS duration",
author = "Whitbeck, {Matthew G.} and Charnigo, {Richard J.} and Jignesh Shah and Gustavo Morales and Leung, {Steve W.} and Brandon Fornwalt and Bailey, {Alison L.} and Khaled Ziada and Sorrell, {Vincent L.} and Zegarra, {Milagros M.} and Jenks Thompson and Hosn, {Neil Aboul} and Campbell, {Charles L.} and John Gurley and Paul Anaya and Booth, {David C.} and {Di Biase}, Luigi and Andrea Natale and Susan Smyth and Moliterno, {David J.} and Elayi, {Claude S.}",
year = "2014",
doi = "10.1093/europace/eut335",
language = "English (US)",
volume = "16",
pages = "803--811",
journal = "Europace",
issn = "1099-5129",
publisher = "Oxford University Press",
number = "6",

}

TY - JOUR

T1 - QRS duration predicts death and hospitalization among patients with atrial fibrillation irrespective of heart failure

T2 - Evidence from the AFFIRM study

AU - Whitbeck, Matthew G.

AU - Charnigo, Richard J.

AU - Shah, Jignesh

AU - Morales, Gustavo

AU - Leung, Steve W.

AU - Fornwalt, Brandon

AU - Bailey, Alison L.

AU - Ziada, Khaled

AU - Sorrell, Vincent L.

AU - Zegarra, Milagros M.

AU - Thompson, Jenks

AU - Hosn, Neil Aboul

AU - Campbell, Charles L.

AU - Gurley, John

AU - Anaya, Paul

AU - Booth, David C.

AU - Di Biase, Luigi

AU - Natale, Andrea

AU - Smyth, Susan

AU - Moliterno, David J.

AU - Elayi, Claude S.

PY - 2014

Y1 - 2014

N2 - Aims: The association of QRS duration (QRSd) with morbidity and mortality is understudied in patients with atrial fibrillation (AF). We sought to assess any association of prolonged QRS with increased risk of death or hospitalization among patients with AF. Methods and results: QRS duration was retrieved from the baseline electrocardiograms of patients enroled in the Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) study and divided into three categories: <90, 90-119, <120 ms. Cox models were applied relating the hazards of mortality and hospitalizations to QRSd. Among 3804 patients with AF, 593 died and 2305 were hospitalized. Compared with those with QRS < 90 ms, patients with QRS < 120 ms, had an increased mortality [hazard ratio (HR) 1.61, 95 confidence interval (CI): 1.29-2.03, P < 0.001] and hospitalizations (HR 1.14, 95 CI: 1.07-1.34, P 0.043) over an average follow-up of 3.5 years. Importantly, for patients with QRS 90-119 ms, mortality and hospitalization were also increased (HR 1.31, P 0.005 and 1.11, P 0.026, respectively). In subgroup analysis based on heart failure (HF) status (previously documented or ejection fraction <40), mortality was increased for QRS < 120 ms patients with (HR 1.87, P < 0.001) and without HF (HR 1.63, P 0.02). In the QRS 90-119 ms group, mortality was increased (HR 1.38, P 0.03) for those with HF, but not significantly among those without HF (HR 1.23, P 0.14). Conclusion: Among patients with AF, QRSd < 120 ms was associated with a substantially increased risk for mortality (all-cause, cardiovascular, and arrhythmic) and hospitalization. Interestingly, an increased mortality was also observed among those with QRS 90-119 ms and concomitant HF. All rights reserved.

AB - Aims: The association of QRS duration (QRSd) with morbidity and mortality is understudied in patients with atrial fibrillation (AF). We sought to assess any association of prolonged QRS with increased risk of death or hospitalization among patients with AF. Methods and results: QRS duration was retrieved from the baseline electrocardiograms of patients enroled in the Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) study and divided into three categories: <90, 90-119, <120 ms. Cox models were applied relating the hazards of mortality and hospitalizations to QRSd. Among 3804 patients with AF, 593 died and 2305 were hospitalized. Compared with those with QRS < 90 ms, patients with QRS < 120 ms, had an increased mortality [hazard ratio (HR) 1.61, 95 confidence interval (CI): 1.29-2.03, P < 0.001] and hospitalizations (HR 1.14, 95 CI: 1.07-1.34, P 0.043) over an average follow-up of 3.5 years. Importantly, for patients with QRS 90-119 ms, mortality and hospitalization were also increased (HR 1.31, P 0.005 and 1.11, P 0.026, respectively). In subgroup analysis based on heart failure (HF) status (previously documented or ejection fraction <40), mortality was increased for QRS < 120 ms patients with (HR 1.87, P < 0.001) and without HF (HR 1.63, P 0.02). In the QRS 90-119 ms group, mortality was increased (HR 1.38, P 0.03) for those with HF, but not significantly among those without HF (HR 1.23, P 0.14). Conclusion: Among patients with AF, QRSd < 120 ms was associated with a substantially increased risk for mortality (all-cause, cardiovascular, and arrhythmic) and hospitalization. Interestingly, an increased mortality was also observed among those with QRS 90-119 ms and concomitant HF. All rights reserved.

KW - Arrhythmia

KW - Atrial fibrillation

KW - Bundle branch block

KW - Heart failure

KW - QRS duration

UR - http://www.scopus.com/inward/record.url?scp=84901818275&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84901818275&partnerID=8YFLogxK

U2 - 10.1093/europace/eut335

DO - 10.1093/europace/eut335

M3 - Article

VL - 16

SP - 803

EP - 811

JO - Europace

JF - Europace

SN - 1099-5129

IS - 6

ER -