Ryan G Aleong1, William H Sauer2, Gordon Davis3, Michael R Bristow4. 1. Division of Cardiology, University of Colorado, Aurora. Electronic address: ryan.aleong@ucdenver.edu. 2. Division of Cardiology, University of Colorado, Aurora. 3. ARCA biopharma, Inc., Westminster, Colo. 4. Division of Cardiology, University of Colorado, Aurora; ARCA biopharma, Inc., Westminster, Colo.
Abstract
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.
RCT Entities:
BACKGROUND:Atrial fibrillation and heart failure with reduced left ventricular ejection fraction have interrelated pathophysiologies. New-onset atrial fibrillation in heart failurepatients 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 failurepatients, new-onset atrial fibrillation is a predictor of and trigger for clinical heart failure progression.
Authors: Jonathan P Piccini; William T Abraham; Christopher Dufton; Ian A Carroll; Jeff S Healey; Dirk J van Veldhuisen; William H Sauer; Inder S Anand; Michel White; Stephen B Wilton; Ryan Aleong; Michiel Rienstra; Steven K Krueger; Felix Ayala-Paredes; Yaariv Khaykin; Bela Merkely; Vladimir Miloradović; Jerzy K Wranicz; Leonard Ilkhanoff; Paul D Ziegler; Gordon Davis; Laura L Emery; Debra Marshall; David P Kao; Michael R Bristow; Stuart J Connolly Journal: JACC Heart Fail Date: 2019-04-29 Impact factor: 12.035
Authors: X J Wei; M Han; F Y Yang; G C Wei; Z G Liang; H Yao; C W Ji; R S Xie; C L Gong; Y Tian Journal: Braz J Med Biol Res Date: 2015-08-25 Impact factor: 2.590
Authors: Fouad Chouairi; Justin Pacor; P Elliott Miller; Michael A Fuery; Cesar Caraballo; Sounok Sen; Eric S Leifer; G Michael Felker; Mona Fiuzat; Christopher M O'Connor; James L Januzzi; Daniel J Friedman; Nihar R Desai; Tariq Ahmad; James V Freeman Journal: Mayo Clin Proc Innov Qual Outcomes Date: 2021-04-08