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Author Notes:

Alvaro Alonso, alvaro.alonso@emory.edu

Miriam A. M. Nji: conceptualization, methodology, formal analysis, writing – original draft, visualization. Scott D. Solomon: methodology, investigation, writing – review and editing, funding acquisition. Lin Yee Chen: methodology, writing – review and editing. Amil M. Shah: methodology, investigation, writing – review and editing. Elsayed Z. Soliman: methodology, investigation, writing – review and editing. Aniqa B. Alam: data curation, writing – review and editing. Vinita Subramanya: conceptualization, writing – review and editing. Alvaro Alonso: conceptualization, methodology, validation, formal analysis, supervision, funding acquisition, project administration.

The authors thank the staff and participants of the ARIC study for their important contributions.

The authors report no conflicts of interest


Research Funding:

The Atherosclerosis Risk in Communities study has been funded in whole or in part with Federal funds from the National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, under Contract nos. (HHSN268201700001I, HHSN268201700002I, HHSN268201700003I, HHSN268201700005I, HHSN268201700004I).

Research reported in this publication was also supported by the National Heart, Lung, And Blood Institute of the National Institutes of Health under Award Number K24HL148521 and American Heart Association grant 16EIA26410001 (Alonso). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.


  • Science & Technology
  • Life Sciences & Biomedicine
  • Cardiac & Cardiovascular Systems
  • Cardiovascular System & Cardiology
  • Atrial fibrillation
  • Heart failure
  • Epidemiology

Association of heart failure subtypes and atrial fibrillation: Data from the Atherosclerosis Risk in Communities (ARIC) study


Journal Title:



Volume 339


, Pages 47-53

Type of Work:

Article | Post-print: After Peer Review


Aims: To determine the prevalence and incidence of AF among HF subtypes in a biracial community-based cohort. Methods: We studied 6496 participants in the Atherosclerosis Risk in Community study (mean age, 75.8 ± 5.3, 59% women, 23% black) who attended the 2011–2013 visit. HF was identified from physician adjudicated diagnosis, hospital discharges, and self-report. HF subtypes were based on echocardiography. A left ventricular ejection fraction <40% represents HF with reduced ejection fraction (HFrEF), 40%–49% for HF with midrange ejection fraction (HFmEF), and ≥ 50% for HF with preserved ejection fraction (HFpEF). AF was ascertained through 2017 from study electrocardiograms, hospital discharges, and death certificates. Confounder-adjusted logistic regression and Cox models were used to estimate associations of HF subtype with prevalent and incident AF. Results: Among eligible participants, 393 had HF (HFpEF = 232, HFmEF = 41, HFrEF = 35 and unclassified HF = 85) and 735 had AF. Compared to those without HF, all HF subtypes were more likely to have prevalent AF [odds ratio (95% confidence interval (CI)) 7.4 (5.6–9.9) for HFpEF, 8.1 (4.3–15.3) for HFmEF, 10.0 (5.0–20.2) for HFrEF, 8.8 (5.6–14.0) for unclassified HF]. Among participants without AF at baseline (n = 5761), 610 of them developed AF. Prevalent HF was associated with increased risk of AF [hazard ratio (95%CI) 2.3 (1.6–3.2) for HFpEF, 5.0 (2.7–9.3) for HFmEF, 3.5 (1.7–7.6) for HFrEF, 1.9 (0.9–3.7) for unclassified HF]. Conclusion: AF and HF frequently co-occur, with small differences by HF subtype, underscoring the importance of understanding the interplay of these two epidemics and evaluating shared preventive and therapeutic strategies.

Copyright information:

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (https://creativecommons.org/licenses/by-nc-nd/4.0/).
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