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Incidence and Predictors of Heart Failure in Patients With Atrial Fibrillation

Krisai, Philipp ; Johnson, Linda S.B. LU ; Moschovitis, Giorgio ; Benz, Alexander ; Ramasundarahettige, Chinthanie ; McIntyre, William F. ; Wong, Jorge A. ; Conen, David ; Sticherling, Christian and Connolly, Stuart J. , et al. (2021) In CJC Open 3(12). p.1482-1489
Abstract

Background: Heart failure (HF) is a frequent cause of hospitalization and death in patients with atrial fibrillation (AF). Identifying AF patients at risk of HF hospitalization could help select individuals for intensive follow-up and treatment. Methods: We pooled data from 3 randomized trials (ACTIVE-A, RE-LY, AVERROES) of AF patients, for derivation and internal validation of a risk score for first HF hospitalization. Secondary endpoints were cardiovascular death and a composite of HF hospitalizations and cardiovascular death. Results: In 23,503 patients, the mean age was 71.3 years, and 62% were male. Over a mean follow-up of 2.0 years, 875 patients (3.7%) experienced their first HF hospitalization, and 1037 patients (4.4%) died from... (More)

Background: Heart failure (HF) is a frequent cause of hospitalization and death in patients with atrial fibrillation (AF). Identifying AF patients at risk of HF hospitalization could help select individuals for intensive follow-up and treatment. Methods: We pooled data from 3 randomized trials (ACTIVE-A, RE-LY, AVERROES) of AF patients, for derivation and internal validation of a risk score for first HF hospitalization. Secondary endpoints were cardiovascular death and a composite of HF hospitalizations and cardiovascular death. Results: In 23,503 patients, the mean age was 71.3 years, and 62% were male. Over a mean follow-up of 2.0 years, 875 patients (3.7%) experienced their first HF hospitalization, and 1037 patients (4.4%) died from cardiovascular causes. Incidence rates per 100 patient-years were 1.85 for HF hospitalizations, 2.15 for cardiovascular death, and 3.71 for the composite. Independent predictors for HF hospitalizations included the following: increased age, weight, heart rate and serum creatinine level, lower height and systolic blood pressure, diabetes, vascular disease, valvular disease, heart rhythm, left ventricular hypertrophy, and intraventricular conduction delay. The C-statistic (95% confidence intervals by bootstrap simulations) was 0.717 (0.705-0.732). At 2 years of follow-up, the incidence rate of the primary outcome increased across risk-score quintiles: 0.49, 0.87, 1.29, 2.44, and 4.51 per 100 patient-years, respectively. Patients in the highest quintile had an absolute risk of 6.8% for the primary endpoint at 2 years. Conclusions: In a large AF population, new-onset HF was common. A combination of characteristics can identify high-risk patients for whom strategies to prevent HF should be considered.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
in
CJC Open
volume
3
issue
12
pages
1482 - 1489
publisher
Elsevier
external identifiers
  • pmid:34993460
  • scopus:85119915064
ISSN
2589-790X
DOI
10.1016/j.cjco.2021.07.016
language
English
LU publication?
yes
id
cdbc4b3d-55f5-4507-bb12-f8da76ff4cb2
date added to LUP
2021-12-14 14:32:28
date last changed
2024-04-20 17:44:28
@article{cdbc4b3d-55f5-4507-bb12-f8da76ff4cb2,
  abstract     = {{<p>Background: Heart failure (HF) is a frequent cause of hospitalization and death in patients with atrial fibrillation (AF). Identifying AF patients at risk of HF hospitalization could help select individuals for intensive follow-up and treatment. Methods: We pooled data from 3 randomized trials (ACTIVE-A, RE-LY, AVERROES) of AF patients, for derivation and internal validation of a risk score for first HF hospitalization. Secondary endpoints were cardiovascular death and a composite of HF hospitalizations and cardiovascular death. Results: In 23,503 patients, the mean age was 71.3 years, and 62% were male. Over a mean follow-up of 2.0 years, 875 patients (3.7%) experienced their first HF hospitalization, and 1037 patients (4.4%) died from cardiovascular causes. Incidence rates per 100 patient-years were 1.85 for HF hospitalizations, 2.15 for cardiovascular death, and 3.71 for the composite. Independent predictors for HF hospitalizations included the following: increased age, weight, heart rate and serum creatinine level, lower height and systolic blood pressure, diabetes, vascular disease, valvular disease, heart rhythm, left ventricular hypertrophy, and intraventricular conduction delay. The C-statistic (95% confidence intervals by bootstrap simulations) was 0.717 (0.705-0.732). At 2 years of follow-up, the incidence rate of the primary outcome increased across risk-score quintiles: 0.49, 0.87, 1.29, 2.44, and 4.51 per 100 patient-years, respectively. Patients in the highest quintile had an absolute risk of 6.8% for the primary endpoint at 2 years. Conclusions: In a large AF population, new-onset HF was common. A combination of characteristics can identify high-risk patients for whom strategies to prevent HF should be considered.</p>}},
  author       = {{Krisai, Philipp and Johnson, Linda S.B. and Moschovitis, Giorgio and Benz, Alexander and Ramasundarahettige, Chinthanie and McIntyre, William F. and Wong, Jorge A. and Conen, David and Sticherling, Christian and Connolly, Stuart J. and Healey, Jeff S.}},
  issn         = {{2589-790X}},
  language     = {{eng}},
  number       = {{12}},
  pages        = {{1482--1489}},
  publisher    = {{Elsevier}},
  series       = {{CJC Open}},
  title        = {{Incidence and Predictors of Heart Failure in Patients With Atrial Fibrillation}},
  url          = {{http://dx.doi.org/10.1016/j.cjco.2021.07.016}},
  doi          = {{10.1016/j.cjco.2021.07.016}},
  volume       = {{3}},
  year         = {{2021}},
}