Impact of initial heart failure emergence on clinical outcomes of atrial fibrillation patients in the AFFIRM trial - 05/02/20
Abstract |
Background |
Heart failure (HF) emergence in atrial fibrillation (AF) patients undergoing different treatment strategies has not been studied.
Methods |
AFFIRM trial subjects with no history of HF, without clinical HF and normal left ventricular ejection fraction at enrollment were identified. The principal outcome was time to development of a composite of New York Heart Association class ≥II HF and/or cardiovascular (CV) death. It was compared for rate and rhythm strategies and correlated with electrocardiographic parameters on follow-up (FU).
Results |
A total of 1,771 patients (880 rate, 891 rhythm) were evaluated. The principal outcome occurred in 21.4% of rate and 16.8% of rhythm subjects at 5 years (hazard ratio [HR] 1.32, 95% CI 1.04-1.69, P = .024). HF increment by 2 classes increased total mortality (HR 2.83, 95% CI 1.91-4.18, P < .0001), cardiac mortality, (HR 4.27, 95% CI 2.03-9.04, P = .0001), and CV hospitalizations (HR 3.04, 95% CI 2.15-4.29, P < .0001). HF emergence during FU was associated with AF (P = .0004), ventricular rate >80 beats/min (P = .0106), and higher frequency of recorded AF in the rhythm arm (25%-75% vs <25%, HR 1.69, 95% CI 1.09-2.64, P = .020; >75% vs <25%, HR 3.15, 95% CI 1.87-5.34, P =< .001).
Conclusions |
(1) In AF patients without HF, symptomatic HF emergence was more frequent with rate control than with rhythm control. (2) HF appearance presages increased mortality risk. (3) Delaying HF emergence is associated with effective rhythm control with documented sinus rhythm during >75% of FU visits as well as ventricular rate control.
Le texte complet de cet article est disponible en PDF.Plan
| The authors are solely responsible for the design and conduct of this study, all study analyses, and the drafting and editing of the paper. |
|
| Presented in part at the Annual Scientific Sessions of the European Society of Cardiology, Munich, Germany, August 2018, and the Annual Scientific Sessions of the Heart Rhythm Society, San Francisco, May 2019. |
|
| No extramural funding was used to support this work. |
Vol 220
P. 1-11 - février 2020 Retour au numéro
Article précédent
- Cardiac Sarcoidosis multi-center randomized controlled trial (CHASM CS- RCT)
- David Birnie, Rob S.B. Beanlands, Pablo Nery, Shawn D. Aaron, Daniel A. Culver, Robert A. DeKemp, Lorne Gula, Andrew Ha, Jeffery S. Healey, Yuko Inoue, Mark A. Judson, Daniel Juneau, Kengo Kusano, Russell Quinn, Lena Rivard, Mustafa Toma, Amanda Varnava, George Wells, Melissa Wickremasinghe, Jordana Kron
- Four-year trends in oral anticoagulant use and declining rates of ischemic stroke among 194,030 atrial fibrillation patients drawn from a sample of 12 million people
- Aldo P. Maggioni, Letizia Dondi, Felicita Andreotti, Antonella Pedrini, Silvia Calabria, Giulia Ronconi, Carlo Piccinni, Nello Martini
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?