João Pedro Ferreira1, John G Cleland2, Carolyn S P Lam3,4, Stefan D Anker5,6, Mandeep R Mehra7, Dirk J van Veldhuisen4, William M Byra8, David A LaPolice8, Barry Greenberg9, Faiez Zannad10. 1. Centre D'Investigation Clinique 1433 Module Plurithématique, CHRU Nancy - Hopitaux de Brabois, CHRU de Nancy, FCRIN INI-CRCT, Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu, Université de Lorraine, Nancy, France. j.ferreira@chru-nancy.fr. 2. Robertson Centre for Biostatistics and Clinical Trials, University of Glasgow, Glasgow, Scotland. 3. National Heart Centre Singapore, Duke-National University of Singapore, Singapore, Singapore. 4. Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands. 5. Berlin-Brandenburg Center for Regenerative Therapies, Berlin, Germany. 6. Department of Cardiology, German Center for Cardiovascular Research Partner Site Berlin, Charite Universitatsmedizin Berlin, Berlin, Germany. 7. Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. 8. Janssen Research and Development, Raritan, NJ, USA. 9. Cardiology Division, Department of Medicine, University of California, San Diego, La Jolla, USA. 10. Centre D'Investigation Clinique 1433 Module Plurithématique, CHRU Nancy - Hopitaux de Brabois, CHRU de Nancy, FCRIN INI-CRCT, Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu, Université de Lorraine, Nancy, France. f.zannad@chru-nancy.fr.
Abstract
BACKGROUND: Atrial fibrillation (AF) in the presence of heart failure (HF) is associated with poor outcomes including a high-risk of stroke and other thromboembolic events. Identifying patients without AF who are at high-risk of developing this arrhythmia has important clinical implications. AIMS: To develop a risk score to identify HF patients at high risk of developing AF. METHODS: The COMMANDER-HF trial enrolled 5022 patients with HF and a LVEF ≤ 40%, history of coronary artery disease, and absence of AF at baseline (confirmed with an electrocardiogram). Patients were randomized to either rivaroxaban (2.5 mg bid) or placebo. New-onset AF was confirmed by the investigator at study visits. RESULTS: 241 (4.8%) patients developed AF during the follow-up (median 21 months). Older age (≥ 65 years), LVEF < 35%, history of PCI or CABG, White race, SBP < 110 mmHg, and higher BMI (≥ 25 kg/m2) were independently associated with risk of new-onset AF, whereas the use of DAPT was associated with a lower risk of new-onset AF. We then built a risk score from these variables (with good accuracy C-index = 0.71) and calibration across observed and predicted tertiles of risk. New-onset AF events rates increased steeply by increasing tertiles of the risk-score. Compared to tertile 1, the risk of new-onset AF was 2.5-fold higher in tertile 2, and 6.3-fold higher in tertile 3. Rivaroxaban had no effect in reducing new-onset AF. In time-updated models, new-onset AF was associated with a higher risk of subsequent all-cause death: HR (95%CI) 1.38 (1.11-1.73). CONCLUSIONS: A well-calibrated risk-score identified patients at risk of new-onset AF in the COMMANDER-HF trial. Patients who developed AF had a higher risk of subsequent death. Risk of new-onset atrial fibrillation in patients with HFrEF and coronary artery disease.
BACKGROUND: Atrial fibrillation (AF) in the presence of heart failure (HF) is associated with poor outcomes including a high-risk of stroke and other thromboembolic events. Identifying patients without AF who are at high-risk of developing this arrhythmia has important clinical implications. AIMS: To develop a risk score to identify HF patients at high risk of developing AF. METHODS: The COMMANDER-HF trial enrolled 5022 patients with HF and a LVEF ≤ 40%, history of coronary artery disease, and absence of AF at baseline (confirmed with an electrocardiogram). Patients were randomized to either rivaroxaban (2.5 mg bid) or placebo. New-onset AF was confirmed by the investigator at study visits. RESULTS: 241 (4.8%) patients developed AF during the follow-up (median 21 months). Older age (≥ 65 years), LVEF < 35%, history of PCI or CABG, White race, SBP < 110 mmHg, and higher BMI (≥ 25 kg/m2) were independently associated with risk of new-onset AF, whereas the use of DAPT was associated with a lower risk of new-onset AF. We then built a risk score from these variables (with good accuracy C-index = 0.71) and calibration across observed and predicted tertiles of risk. New-onset AF events rates increased steeply by increasing tertiles of the risk-score. Compared to tertile 1, the risk of new-onset AF was 2.5-fold higher in tertile 2, and 6.3-fold higher in tertile 3. Rivaroxaban had no effect in reducing new-onset AF. In time-updated models, new-onset AF was associated with a higher risk of subsequent all-cause death: HR (95%CI) 1.38 (1.11-1.73). CONCLUSIONS: A well-calibrated risk-score identified patients at risk of new-onset AF in the COMMANDER-HF trial. Patients who developed AF had a higher risk of subsequent death. Risk of new-onset atrial fibrillation in patients with HFrEF and coronary artery disease.
Authors: Azmil H Abdul-Rahim; Ana-Cristina Perez; Rachael L MacIsaac; Pardeep S Jhund; Brian L Claggett; Peter E Carson; Michel Komajda; Robert S McKelvie; Michael R Zile; Karl Swedberg; Salim Yusuf; Marc A Pfeffer; Scott D Solomon; Gregory Y H Lip; Kennedy R Lees; John J V McMurray Journal: Eur Heart J Date: 2017-03-07 Impact factor: 29.983