New-onset Atrial Fibrillation Predicts Heart Failure Progression - 12/10/14
, William H. Sauer, MD a, Gordon Davis, MS b, Michael R. Bristow, MD, PhD a, bAbstract |
Background |
Atrial fibrillation and heart failure with reduced left ventricular ejection fraction have interrelated pathophysiologies. New-onset atrial fibrillation in heart failure patients has been associated with increased mortality, but has not been definitively related to clinical heart failure progression.
Methods |
To test the hypothesis that new-onset atrial fibrillation is related to clinical heart failure progression, in 2392 patients without atrial fibrillation at randomization in the Beta-blocker Evaluation of Survival Trial we measured clinical endpoints in patients who did (Group 1, n = 190) or did not (Group 2, n = 2202) develop new-onset atrial fibrillation. Results were also compared with the 303 patients who entered the trial in atrial fibrillation (Baseline/chronic group), and in Group 1/2 patients we conducted a multivariate analysis of covariates potentially related to time to first heart failure hospitalization.
Results |
Compared with Group 2, Group 1 patients post atrial fibrillation onset had a ∼2-fold increase in mortality (P < .0001) and a ∼4.5-fold increase in all-cause or heart failure hospitalization days/patient (hospitalization burden, both P < .0001). In Group 1, both types of hospitalization burden were 2.9-fold greater than in the Baseline/chronic group (P < .001), and hospitalization burden increased ∼6-fold (P < .0001) compared with the pre-event period. On multivariate analysis, new-onset atrial fibrillation was a highly significant (P < .00001) predictor of heart failure hospitalization.
Conclusions |
In addition to being a discrete electrophysiologic event, in heart failure patients, new-onset atrial fibrillation is a predictor of and trigger for clinical heart failure progression.
Le texte complet de cet article est disponible en PDF.Keywords : Atrial fibrillation, Beta-blockers, Heart failure markers, HFrEF
Plan
| Clinical Trial Registration: Clinicaltrials.gov NCT00000560. |
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| Funding: Funding was received from the VA Cooperative Studies Program, the National Heart, Lung, and Blood Institute, and ARCA biopharma. |
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| Conflicts of Interest: GD is an employee of ARCA biopharma, and MRB is an ARCA employee, officer, and director. RGA and WHS have no conflicts. |
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| Authorship: All authors had access to the data, and all either wrote portions of the manuscript or edited it. |
Vol 127 - N° 10
P. 963-971 - octobre 2014 Retour au numéro
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