Jesse F Veenis1, Hans-Peter Brunner-La Rocca2, Gerard C M Linssen3, Frank J J Smeele4, Noëmi T A E Wouters5, Paul H M Westendorp6, Philip C Rademaker7, Martin E W Hemels8, Michiel Rienstra9, Arno W Hoes10, Jasper J Brugts11. 1. Erasmus MC, University Medical Center Rotterdam, Thorax Center, Department of Cardiology, Rotterdam, the Netherlands. 2. Department of Cardiology, Maastricht University Medical Centre, Maastricht, the Netherlands. 3. Department of Cardiology, Hospital Group Twente, Almelo and Hengelo, the Netherlands. 4. Department of Cardiology, Slingeland Ziekenhuis, Doetinchem, the Netherlands. 5. Department of Cardiology, Amphia Ziekenhuis, Breda, the Netherlands. 6. Department of Cardiology, Rivas Beatrixziekenhuis, Gronichem, the Netherlands. 7. Department of Cardiology, ZorgZaam Ziekenhuis, Terneuzen, the Netherlands. 8. Department of Cardiology, Rijnstate Ziekenhuis, Arnhem, the Netherlands. 9. Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands. 10. Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, the Netherlands. 11. Erasmus MC, University Medical Center Rotterdam, Thorax Center, Department of Cardiology, Rotterdam, the Netherlands. Electronic address: j.brugts@erasmusmc.nl.
Abstract
BACKGROUND: Atrial fibrillation (AF) is common in chronic heart failure (HF) patients and influences the choice and effects of drug and device therapy. In this large real-world HF registry, we studied whether the presence of AF affects the prescription of guideline-recommended HF therapy. METHODS: We analyzed 8253 patients with chronic HF with reduced ejection fraction (HFrEF) from 34 Dutch outpatient clinics included in the period between 2013 and 2016 treated according to the 2012 ESC guidelines. RESULTS: 2109 (25.6%) of these patients were in AF (mean age 76.8 ± 9.2 years, 65.0% were men) and 6.144 (74.4%) had no AF (mean age 70.7 ± 12.2 years, 63.6% were men). Patients with AF more often received beta-blockers (81.7% vs. 79.7%, p = 0.04), MRAs (57.1% vs. 51.7%, p < 0.01), diuretics (89.7% vs. 80.6%, p < 0.01) and digoxin (40.1% vs. 9.3%, p < 0.01) compared to patients without AF, whereas they less often receive renin-angiotensin-system (RAS)-inhibitors (76.1% vs. 83.1%, p < 0.01). The number of patients who received beta-blockers, RAS-inhibitor and MRA at ≥50% of the recommended target dose was comparable between those with and without AF (16.6% vs. 15.2%, p = 0.07). CONCLUSION: In this large cohort of chronic HFrEF patients, the prevalence of AF was high and we observed significant differences in prescription of both guideline-recommended HF between patients with and without AF.
BACKGROUND:Atrial fibrillation (AF) is common in chronic heart failure (HF) patients and influences the choice and effects of drug and device therapy. In this large real-world HF registry, we studied whether the presence of AF affects the prescription of guideline-recommended HF therapy. METHODS: We analyzed 8253 patients with chronic HF with reduced ejection fraction (HFrEF) from 34 Dutch outpatient clinics included in the period between 2013 and 2016 treated according to the 2012 ESC guidelines. RESULTS: 2109 (25.6%) of these patients were in AF (mean age 76.8 ± 9.2 years, 65.0% were men) and 6.144 (74.4%) had no AF (mean age 70.7 ± 12.2 years, 63.6% were men). Patients with AF more often received beta-blockers (81.7% vs. 79.7%, p = 0.04), MRAs (57.1% vs. 51.7%, p < 0.01), diuretics (89.7% vs. 80.6%, p < 0.01) and digoxin (40.1% vs. 9.3%, p < 0.01) compared to patients without AF, whereas they less often receive renin-angiotensin-system (RAS)-inhibitors (76.1% vs. 83.1%, p < 0.01). The number of patients who received beta-blockers, RAS-inhibitor and MRA at ≥50% of the recommended target dose was comparable between those with and without AF (16.6% vs. 15.2%, p = 0.07). CONCLUSION: In this large cohort of chronic HFrEF patients, the prevalence of AF was high and we observed significant differences in prescription of both guideline-recommended HF between patients with and without AF.