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Heart, Lung and Circulation Abstracts S1492008;17S:S1–S209

352The Prognostic Implications of Atrial Fibrillation inPatients with Heart Failure: A Meta-Analysis

Adele Pope ∗, Cara Wasywich, Jith Somaratne, KatrinaPoppe, Rob Doughty, Gillian Whalley

University of Auckland, Auckland, New Zealand

Atrial fibrillation (AF) frequently coexists with heart fail-ure (HF) and both are independently associated withworse prognosis, however, there remains controversy overthe further prognostic impact of AF in patients with HF. Ameta-analysis was carried out to compare mortality withAF versus sinus rhythm (SR) in patients with HF.Methods: On-line medical databases were searched forstudies of patients with established HF which comparedmortality by AF and SR. Analysis was performed usingreview manager software (V4.2.7, Cochrane Collabora-tion).Results: 22 studies were included (9 clinical trials, 12clinical cohorts (9 prospective and 3 retrospective), and1 prospective registry) involving 32,242 patients: AF,N = 5805; SR, n = 27,437. Follow-up period varied from 1to 9 years. Patients in AF were older than those withSR (pooled mean age 70 years vs. 65 years, respectively).Pooled mean left ventricular ejection fraction (LVEF) wassimilar in patients with AF and SR (33.6% vs. 32.5%). A totalof 11,056 patients died during follow-up (2542 in AF and8otCtwwtliga

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of the heart failure (n = 29) population compared to therespiratory (n = 152) and malignant (n = 67) populations.Method: On the day of screening, participants rated theirlevel of physical functioning and then retrospectively ratedtheir physical functioning score for 4 weeks and 6 monthspreviously using two scales (Australian modified Karnof-sky Performance Scale and Eastern Cooperative OncologyGroup scale).Results: There was an obvious decline in the level of phys-ical functioning of the malignant group over the 6 monthsprior to screening. Whilst the heart failure group’s levelof physical functioning remained constant throughoutthis period, it was significantly lower (Karnofsky p < 0.03;ECOG p < 0.02) then the respiratory group at all timepoints, and the malignant group for 6 months previously(Karnofsky p = 0.005; ECOG p < 0.001). There was no differ-ence between the malignant group and the heart failuregroup in the four weeks up to the day of screening.Conclusion: These data support some conceptual mod-els of the illness trajectory of advanced disease. Furtherstudies are required that prospectively documents thistrajectory.

doi:10.1016/j.hlc.2008.05.354

354Hot Weather and Heart Failure: Seasonal Variations inMorbidity and Mortality in South Australian Heart Fail-u

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514 in SR) giving an overall weighted odds ratio for deathf 1.46 (95% CI: 1.25–1.70) in patients with AF compared tohose with SR.onclusion: This literature based meta-analysis supports

he hypothesis that the presence of AF is associated withorsened prognosis for patients in HF. It is not clearhether this increased risk of mortality is directly linked to

he coexistence of AF independent of other cardiovascu-ar disease risk factors such as age, LVEF or underlyingschaemic heart disease. Further clarification would beained from carrying out an individual patient meta-nalysis.

oi:10.1016/j.hlc.2008.05.353

53he Malignant Trajectory of Heart Failure

hillip Newton 1,∗, Patricia Davidson 1, Amy Abernethy 2,avid Currow 3

Curtin University of Technology, Sydney, NSW, Australia;Duke University Medical Centre, Durham, NC, United States;Flinders University, Adelaide, SA, Australia

ackground: Conceptual models have been developedhich have attempted to represent the decline in phys-

cal functioning of advanced disease, in particular thoseith malignant conditions compared to end-stage organ

ailure.im: As part of the O2 Breathe study, a multinational,

andomised double blind controlled trial of oxygen ther-py in people with a progressive life limiting illness, thistudy sought to compare the level of physical limitation

re Patients (1994–2005)

ally Inglis 1,3,∗, Robyn Clark 2,3, Sepehr Shakib 2,3, Denisong 2,3, Payman Molaee 2,3, David Wilkinson 1,3, Simon

tewart 1,3

University of Queensland, Brisbane, Australia; 2 Royal Ade-aide Hospital, Adelaide, Australia; 3 Baker Heart Researchnstitute, Melbourne, Australia

ackground: There are minimal reports of seasonal vari-tions in chronic heart failure (CHF)-related morbiditynd mortality beyond the northern hemisphere. Whatnfluence high summer temperatures and milder winteremperatures have on CHF morbidity and mortality of iset to be determined.ethod: We retrospectively analysed longitudinal rou-

inely collected clinical data for 2961 patients with aonfirmed diagnosis of CHF from a tertiary referral hos-ital in Southern Australia and examined the potentialeasonal variations in respect to morbidity and all-causeortality over more than a decade.esults: Seasonal variation across all event-types wasbserved. CHF-related hospitalisations peaked in winterJuly) and were lowest in summer (February): 70 (95%I: 65–76) vs. 33 (95% CI: 30–37) admissions/1000 at

isk (p < 0.005). All-cause hospitalisations were consistentlyigher in winter (113 (95% CI: 107–120) vs. 73 (95% CI:8–79) admissions/1000 at risk, p < 0.001). The proportionf concurrent respiratory disease was also consistently higher

n winter (21% vs. 12%, p < 0.001). All-cause mortality wasighest in August (winter) relative to February (summer):3 (95% CI: 20–27) vs. 12 (95% CI: 10–15) deaths per 1000 at