BACKGROUND:Heart failure (HF) complicated by atrial fibrillation/flutter (AF/AFL) is associated with worse outcomes. However, the clinical profile and outcomes of patients following hospitalization for HF with AF/AFL on initial electrocardiogram (ECG) has not been well studied. METHODS: EVEREST was a randomized trial of vasopressin-2 receptor blockade, in addition to standard therapy, in 4133 patients hospitalized with HF with ejection fraction ≤40%. A post hoc analysis was performed comparing the clinical characteristics and outcomes [all-cause mortality and cardiovascular mortality/HF hospitalization] of patients with AF/AFL versus sinus rhythm (SR) on baseline ECG, which were centrally analyzed. Times to events were compared using log-rank tests and Cox regression models. RESULTS: Of the 4133 patients, 1195 (29%) were classified with AF/AFL and 2071(50%) with SR. The remaining patients (21%) were excluded because ECGs were unavailable (n = 106), rhythm was paced (n = 727), or junctional/other supraventricular (n = 34). AF/AFL patients were older, with increased weight, faster heart rate, higher blood urea nitrogen, and natriuretic peptide levels compared to SR patients. Anticoagulation was prescribed in 67% of AF/AFL patients on discharge. AF/AFL patients were less likely to receive β-blockers or angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (all P < .05). After risk adjustment, AF/AFL was associated with increased mortality (hazard ratio 1.23; 95% CI, 1.04-1.46) and cardiovascular mortality/HF hospitalization (hazard ratio 1.26; 95% CI, 1.07-1.47). CONCLUSION:AF/AFL on initial ECG in patients hospitalized with HF with reduced ejection fraction is associated with lower use of evidence-based therapies and increased mortality and rehospitalization compared to patients in SR.
RCT Entities:
BACKGROUND:Heart failure (HF) complicated by atrial fibrillation/flutter (AF/AFL) is associated with worse outcomes. However, the clinical profile and outcomes of patients following hospitalization for HF with AF/AFL on initial electrocardiogram (ECG) has not been well studied. METHODS: EVEREST was a randomized trial of vasopressin-2 receptor blockade, in addition to standard therapy, in 4133 patients hospitalized with HF with ejection fraction ≤40%. A post hoc analysis was performed comparing the clinical characteristics and outcomes [all-cause mortality and cardiovascular mortality/HF hospitalization] of patients with AF/AFL versus sinus rhythm (SR) on baseline ECG, which were centrally analyzed. Times to events were compared using log-rank tests and Cox regression models. RESULTS: Of the 4133 patients, 1195 (29%) were classified with AF/AFL and 2071(50%) with SR. The remaining patients (21%) were excluded because ECGs were unavailable (n = 106), rhythm was paced (n = 727), or junctional/other supraventricular (n = 34). AF/AFL patients were older, with increased weight, faster heart rate, higher blood ureanitrogen, and natriuretic peptide levels compared to SR patients. Anticoagulation was prescribed in 67% of AF/AFL patients on discharge. AF/AFL patients were less likely to receive β-blockers or angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (all P < .05). After risk adjustment, AF/AFL was associated with increased mortality (hazard ratio 1.23; 95% CI, 1.04-1.46) and cardiovascular mortality/HF hospitalization (hazard ratio 1.26; 95% CI, 1.07-1.47). CONCLUSION:AF/AFL on initial ECG in patients hospitalized with HF with reduced ejection fraction is associated with lower use of evidence-based therapies and increased mortality and rehospitalization compared to patients in SR.
Authors: Ravi B Patel; Muthiah Vaduganathan; Aruna Rikhi; Hrishikesh Chakraborty; Stephen J Greene; Adrian F Hernandez; G Michael Felker; Margaret M Redfield; Javed Butler; Sanjiv J Shah Journal: JACC Heart Fail Date: 2018-11-05 Impact factor: 12.035
Authors: Stephen J Greene; Gregg C Fonarow; Scott D Solomon; Haris P Subacius; Andrew P Ambrosy; Muthiah Vaduganathan; Aldo P Maggioni; Michael Böhm; Eldrin F Lewis; Faiez Zannad; Javed Butler; Mihai Gheorghiade Journal: Eur J Heart Fail Date: 2016-10-17 Impact factor: 15.534
Authors: Erik Fung; Marjo-Riitta Järvelin; Rahul N Doshi; Jerold S Shinbane; Steven K Carlson; Luanda P Grazette; Philip M Chang; Rajbir S Sangha; Heikki V Huikuri; Nicholas S Peters Journal: Front Physiol Date: 2015-05-27 Impact factor: 4.566
Authors: Fernanda de Souza Nogueira Sardinha Mendes; Jacob Atié; Marcelo Iorio Garcia; Eliza de Almeida Gripp; Andréa Silvestre de Sousa; Luiz Augusto Feijó; Sergio Salles Xavier Journal: Arq Bras Cardiol Date: 2014-08-29 Impact factor: 2.000
Authors: Michael J Diamant; Jason G Andrade; Sean A Virani; Pardeep S Jhund; Mark C Petrie; Nathaniel M Hawkins Journal: ESC Heart Fail Date: 2021-09-10