<p> </p> <p><strong>Abstract</strong></p> <p><strong>Objective: </strong>To evaluate the association between pre-diabetes and HF and the association of HF with changes in glycaemic status. </p> <p><strong>Design and Methods: </strong>Patients newly diagnosed with AF between 2015 and 2018 were divided into 3 groups (normoglycaemia, pre-diabetes, and type 2 diabetes) according to their baseline glycaemic status. The primary outcome was incident HF. Fine and Gray model was applied, with death

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... ed as the competing event. </p> <p><strong>Results</strong>: Among 17,943 AF patients (mean age 75.5 years, 47% female), 3,711 (20.7%) had pre-diabetes and 10,127 (56.4%) had diabetes at baseline. Over a median follow-up of 4.7 years, 518 (14%) normoglycaemic, 646 (15.7%) pre-diabetic, and 1,795 (17.7%) diabetic patients developed HF. Pre-diabetes was associated with an increased risk of HF compared with normoglycaemic patients (subdistribution Hazard Ratio (SHR) =1.12, 95% confidence interval (CI): 1.03-1.22). In patients with pre-diabetes at baseline, 403 (11.1%) progressed to diabetes and 311 (8.6%) reversed to normoglycaemia at 2 years. Compared to those who remained pre-diabetic, patients who progressed to diabetes were associated with an increased risk of HF (SHR=1.50, 95% CI: 1.13-1.97), whereas those who reversed to normoglycaemia were associated with decreased risk (SHR=0.61, 95% CI: 0.42-0.94). </p> <p><strong>Conclusions</strong>: Pre-diabetes was associated with an increased risk of HF in patients with AF. Compared with patients who remained pre-diabetic, those who progressed to diabetes at 2 years experienced an increased risk of HF, whereas those who reversed to normoglycaemia incurred a lower risk of HF. </p>