Keitaro Senoo1, Gregory Y H Lip2, Deirdre A Lane1, Harry R Büller1, Dipak Kotecha1. 1. From the University of Birmingham Centre for Cardiovascular Sciences, Cardiovascular Department, City Hospital, Birmingham, United Kingdom (K.S., G.Y.H.L., D.A.L., D.K.); Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark (G.Y.H.L.); and Department of Vascular Medicine, Academic Medical Centre, Amsterdam, The Netherlands (H.R.B.). 2. From the University of Birmingham Centre for Cardiovascular Sciences, Cardiovascular Department, City Hospital, Birmingham, United Kingdom (K.S., G.Y.H.L., D.A.L., D.K.); Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark (G.Y.H.L.); and Department of Vascular Medicine, Academic Medical Centre, Amsterdam, The Netherlands (H.R.B.). g.y.h.lip@bham.ac.uk.
Abstract
BACKGROUND AND PURPOSE: Atrial fibrillation (AF) and heart failure frequently coexist and are associated with increased morbidity and mortality. We investigated the prognosis of anticoagulated patients with permanent AF and nonpermanent AF according to preexisting heart failure in the AMADEUS (Evaluating the Use of SR34006 Compared to Warfarin or Acenocoumarol in Patients With Atrial Fibrillation) trial. METHODS: The primary outcome was a composite of cardiovascular death and stroke or systemic embolism, analyzed using a Cox proportional hazards model, adjusted for baseline age, sex, diabetes mellitus, hypertension, creatinine, and previous cardiovascular diseases. The median follow-up was 11.6 months (interquartile range, 6.2-15.2). RESULTS: Nonpermanent AF was present in 2072 patients (46% of cohort), of which 339 (16%) had preexisting heart failure. A total of 2484 patients had permanent AF (54% of cohort), with a higher burden of heart failure including 730 patients (29%; P<0.001). Overall, death because of cardiovascular causes occurred in 57 patients and 45 had stroke or systemic embolism (1.4/100 person-years for each). Overall, the adjusted incidence of the composite outcome was higher in patients with permanent AF than in patients with nonpermanent AF. In multivariate analysis, permanency of AF, creatinine, prior cerebrovascular events, and previous coronary disease were independently associated with the primary outcome. The hazard ratio for permanent versus nonpermanent AF was 1.68 (95% confidence interval, 1.08-2.55; P=0.02). The presence of heart failure increased the risk of adverse outcomes in a similar way in both permanent and nonpermanent AF (interaction P value=0.76). CONCLUSIONS: The risk of cardiovascular death, stroke, or systemic embolism is higher in anticoagulated patients with permanent AF than in those with nonpermanent AF, regardless of preexisting heart failure.
BACKGROUND AND PURPOSE:Atrial fibrillation (AF) and heart failure frequently coexist and are associated with increased morbidity and mortality. We investigated the prognosis of anticoagulated patients with permanent AF and nonpermanent AF according to preexisting heart failure in the AMADEUS (Evaluating the Use of SR34006 Compared to Warfarin or Acenocoumarol in Patients With Atrial Fibrillation) trial. METHODS: The primary outcome was a composite of cardiovascular death and stroke or systemic embolism, analyzed using a Cox proportional hazards model, adjusted for baseline age, sex, diabetes mellitus, hypertension, creatinine, and previous cardiovascular diseases. The median follow-up was 11.6 months (interquartile range, 6.2-15.2). RESULTS: Nonpermanent AF was present in 2072 patients (46% of cohort), of which 339 (16%) had preexisting heart failure. A total of 2484 patients had permanent AF (54% of cohort), with a higher burden of heart failure including 730 patients (29%; P<0.001). Overall, death because of cardiovascular causes occurred in 57 patients and 45 had stroke or systemic embolism (1.4/100 person-years for each). Overall, the adjusted incidence of the composite outcome was higher in patients with permanent AF than in patients with nonpermanent AF. In multivariate analysis, permanency of AF, creatinine, prior cerebrovascular events, and previous coronary disease were independently associated with the primary outcome. The hazard ratio for permanent versus nonpermanent AF was 1.68 (95% confidence interval, 1.08-2.55; P=0.02). The presence of heart failure increased the risk of adverse outcomes in a similar way in both permanent and nonpermanent AF (interaction P value=0.76). CONCLUSIONS: The risk of cardiovascular death, stroke, or systemic embolism is higher in anticoagulated patients with permanent AF than in those with nonpermanent AF, regardless of preexisting heart failure.
Authors: Brandon W Calenda; Valentin Fuster; Jonathan L Halperin; Christopher B Granger Journal: Nat Rev Cardiol Date: 2016-07-07 Impact factor: 32.419
Authors: Miklos Rohla; Thomas W Weiss; Ladislav Pecen; Giuseppe Patti; Jolanta M Siller-Matula; Renate B Schnabel; Richard Schilling; Dipak Kotecha; Markus Lucerna; Kurt Huber; Raffaele De Caterina; Paulus Kirchhof Journal: BMJ Open Date: 2019-03-30 Impact factor: 2.692
Authors: Dipak Kotecha; Melanie Calvert; Jonathan J Deeks; Michael Griffith; Paulus Kirchhof; Gregory Yh Lip; Samir Mehta; Gemma Slinn; Mary Stanbury; Richard P Steeds; Jonathan N Townend Journal: BMJ Open Date: 2017-07-20 Impact factor: 2.692