Peter Brønnum Nielsen1, Torben Bjerregaard Larsen2, Anders Gorst-Rasmussen2, Flemming Skjøth2, Gregory Y H Lip1. 1. From the Atrial Fibrillation Study Group, Department of Cardiology (P.B.N., T.B.L.) and Unit of Clinical Biostatistics and Bioinformatics (A.G.-R., F.S.), Aalborg University Hospital, Aalborg, Denmark; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark (P.B.N., T.B.L., A.G.-R., F.S., G.Y.H.L.); and Institute for Cardiovascular Sciences, University of Birmingham, City Hospital, Birmingham, United Kingdom (G.Y.H.L.). g.y.h.lip@bham.ac.uk pbn@rn.dk. 2. From the Atrial Fibrillation Study Group, Department of Cardiology (P.B.N., T.B.L.) and Unit of Clinical Biostatistics and Bioinformatics (A.G.-R., F.S.), Aalborg University Hospital, Aalborg, Denmark; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark (P.B.N., T.B.L., A.G.-R., F.S., G.Y.H.L.); and Institute for Cardiovascular Sciences, University of Birmingham, City Hospital, Birmingham, United Kingdom (G.Y.H.L.).
Abstract
BACKGROUND: Recent data suggest that β-blockers are associated with prognostic advantages in heart failure (HF) patients without concomitant atrial fibrillation (AF), but not in HF patients with concomitant AF. We aimed to investigate associations between β-blocker treatment and cardiovascular outcome and mortality in AF patients with and without HF. METHODS AND RESULTS: Three nationwide registries were used to identify patients with nonvalvular AF patients with or without concomitant HF. Patients were stratified into β-blocker users and β-blocker nonusers, and according to the presence of a HF diagnosis. We followed the patients ≤ 5 years after baseline. Six different cardiovascular outcomes were investigated, including all-cause mortality and fatal thromboembolic events. Crude event rates were ascertained and propensity-matched Cox regression was used to compare event rates according to β-blocker usage status. A total of 205,174 patients were included, where 39,741 patients had prevalent HF. In the latter subgroup of patients, the 1-year propensity-matched hazard ratio (HR) for all-cause mortality was 0.75 (95% confidence interval, 0.71-0.79; nontreated used as reference). For patients without concomitant HF, the propensity-matched HR for all-cause mortality was 0.78 (95% confidence interval, 0.71-0.76). CONCLUSIONS: In this large nationwide cohort study, evidence of a lower mortality with β-blocker therapy in AF patients with concomitant HF was observed. In addition, this association was accompanied with indications that β-blocker treatment is also associated with a better prognosis in AF patients without concomitant HF.
BACKGROUND: Recent data suggest that β-blockers are associated with prognostic advantages in heart failure (HF) patients without concomitant atrial fibrillation (AF), but not in HF patients with concomitant AF. We aimed to investigate associations between β-blocker treatment and cardiovascular outcome and mortality in AFpatients with and without HF. METHODS AND RESULTS: Three nationwide registries were used to identify patients with nonvalvular AFpatients with or without concomitant HF. Patients were stratified into β-blocker users and β-blocker nonusers, and according to the presence of a HF diagnosis. We followed the patients ≤ 5 years after baseline. Six different cardiovascular outcomes were investigated, including all-cause mortality and fatal thromboembolic events. Crude event rates were ascertained and propensity-matched Cox regression was used to compare event rates according to β-blocker usage status. A total of 205,174 patients were included, where 39,741 patients had prevalent HF. In the latter subgroup of patients, the 1-year propensity-matched hazard ratio (HR) for all-cause mortality was 0.75 (95% confidence interval, 0.71-0.79; nontreated used as reference). For patients without concomitant HF, the propensity-matched HR for all-cause mortality was 0.78 (95% confidence interval, 0.71-0.76). CONCLUSIONS: In this large nationwide cohort study, evidence of a lower mortality with β-blocker therapy in AFpatients with concomitant HF was observed. In addition, this association was accompanied with indications that β-blocker treatment is also associated with a better prognosis in AFpatients without concomitant HF.
Authors: Lorenzo Gigli; Pietro Ameri; Gianmarco Secco; Gabriele De Blasi; Roberta Miceli; Alessandra Lorenzoni; Francesco Torre; Francesco Chiarella; Claudio Brunelli; Marco Canepa Journal: World J Cardiol Date: 2016-11-26