TY - JOUR
T1 - Mineralocorticoid receptor antagonism in patients with atrial fibrillation
T2 - Findings from the ORBIT-AF (outcomes registry for better informed treatment of atrial fibrillation) registry
AU - Fudim, Marat
AU - Liu, Peter R.
AU - Shrader, Peter
AU - Blanco, Rosalia G.
AU - Allen, Larry A.
AU - Fonarow, Gregg C.
AU - Gersh, Bernard J.
AU - Kowey, Peter R.
AU - Mahaffey, Kenneth W.
AU - Hylek, Elaine
AU - Go, Alan S.
AU - Thomas, Laine
AU - Peterson, Eric D.
AU - Piccini, Jonathan P.
N1 - Funding Information:
This project was supported (in part) by funding from the Agency of Healthcare Research and Quality through cooperative agreement number 1U19 HS021092. The ORBIT-AF registry is sponsored by Janssen Scientific Affairs, LLC, Raritan, NJ.
Funding Information:
Fudim is supported by an American Heart Association grant (17MCPRP33460225) and National Institutes of Health T32 grant (5T32HL007101) and serves as a consultant for Coridea, Cibiem, Galvani, and GE Healthcare. Piccini receives funding for clinical research from ARCA biopharma, Boston Scientific, Gilead, Janssen Pharmaceuticals, ResMed, Spec-tranetics, and St. Jude Medical and serves as a consultant for Allergan, Amgen, GlaxoSmithKline, Johnson & Johnson, Medtronic, and Spectranetics. Allen received research grants from the National Institutes of Health, the American Heart Association, and the Patient-Centered Outcomes Research Institute, and serves as a consultant for Janssen, Novartis, and Boston Scientific. Fonarow serves as a consultant for Amgen, Boston Scientific, Janssen, Johnson & Johnson, Medtronic, Novartis, St. Jude Medical, Takeda, The Medicines Company, and ZS Pharma. The remaining authors have no conflicts of interest to report.
Funding Information:
This project was supported (in part) by funding from the Agency of Healthcare Research and Quality through cooperative agreement number 1U19 HS021092. The ORBIT-AF registry is sponsored by Janssen Scientific Affairs, LLC, Raritan, NJ.Fudim is supported by an American Heart Association grant (17MCPRP33460225) and National Institutes of Health T32 grant (5T32HL007101) and serves as a consultant for Coridea, Cibiem, Galvani, and GE Healthcare. Piccini receives funding for clinical research from ARCA biopharma, Boston Scientific, Gilead, Janssen Pharmaceuticals, ResMed, Spectranetics, and St. Jude Medical and serves as a consultant for Allergan, Amgen, GlaxoSmithKline, Johnson & Johnson, Medtronic, and Spectranetics. Allen received research grants from the National Institutes of Health, the American Heart Association, and the Patient-Centered Outcomes Research Institute, and serves as a consultant for Janssen, Novartis, and Boston Scientific. Fonarow serves as a consultant for Amgen, Boston Scientific, Janssen, Johnson & Johnson, Medtronic, Novartis, St. Jude Medical, Takeda, The Medicines Company, and ZS Pharma. The remaining authors have no conflicts of interest to report.
Publisher Copyright:
© 2018 The Authors.
PY - 2018/4/17
Y1 - 2018/4/17
N2 - Background-—Mineralocorticoid receptor antagonist (MRA) therapy may be beneficial to patients with atrial fibrillation (AF), but little is known about their use in patients with AF and subsequent outcomes. Methods and Results-—In order to better understand MRA use and subsequent outcomes, we performed a retrospective cohort study of the contemporary ORBIT-AF (Outcomes Registry for Better Informed Treatment of Atrial Fibrillation) registry. AF progression and cardiovascular outcomes were compared using propensity-matched Cox proportional hazards modeling according to MRA use at baseline and new MRA use at follow-up versus patients with no MRA use. Among 7012 patients with nonpermanent AF, 320 patients were taking MRA at enrollment, and 416 patients initiated MRA use during follow-up. The mean patient age was 72.5 years, 56.3% were men, and 70.4% had paroxysmal AF. Among all patients taking MRAs, 434 (59.0%) had heart failure, 655 (89.0%) had hypertension, and 380 (51.6%) had both. After adjustment, new MRA use was not associated with reduced AF progression (hazard ratio, 1.18; 95% confidence interval, 0.88–1.58; P=0.27) but showed a trend towards lower risk of stroke, transient ischemic attack, or systemic embolism (hazard ratio, 0.17; 95% confidence interval, 0.02–1.23; P=0.08). Results were similar for a comparison of new MRA users and baseline MRA users compared with nonusers. Conclusions-—In community-based outpatients with AF, the majority of MRA use was for heart failure and hypertension. MRA use also trended towards lower adjusted stroke risk. Future studies should test the hypothesis that MRA use may decrease the risk of stroke in patients with AF.
AB - Background-—Mineralocorticoid receptor antagonist (MRA) therapy may be beneficial to patients with atrial fibrillation (AF), but little is known about their use in patients with AF and subsequent outcomes. Methods and Results-—In order to better understand MRA use and subsequent outcomes, we performed a retrospective cohort study of the contemporary ORBIT-AF (Outcomes Registry for Better Informed Treatment of Atrial Fibrillation) registry. AF progression and cardiovascular outcomes were compared using propensity-matched Cox proportional hazards modeling according to MRA use at baseline and new MRA use at follow-up versus patients with no MRA use. Among 7012 patients with nonpermanent AF, 320 patients were taking MRA at enrollment, and 416 patients initiated MRA use during follow-up. The mean patient age was 72.5 years, 56.3% were men, and 70.4% had paroxysmal AF. Among all patients taking MRAs, 434 (59.0%) had heart failure, 655 (89.0%) had hypertension, and 380 (51.6%) had both. After adjustment, new MRA use was not associated with reduced AF progression (hazard ratio, 1.18; 95% confidence interval, 0.88–1.58; P=0.27) but showed a trend towards lower risk of stroke, transient ischemic attack, or systemic embolism (hazard ratio, 0.17; 95% confidence interval, 0.02–1.23; P=0.08). Results were similar for a comparison of new MRA users and baseline MRA users compared with nonusers. Conclusions-—In community-based outpatients with AF, the majority of MRA use was for heart failure and hypertension. MRA use also trended towards lower adjusted stroke risk. Future studies should test the hypothesis that MRA use may decrease the risk of stroke in patients with AF.
KW - Atrial fibrillation
KW - Mineralocorticoid antagonist
KW - Stroke
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U2 - 10.1161/JAHA.117.007987
DO - 10.1161/JAHA.117.007987
M3 - Article
C2 - 29654203
AN - SCOPUS:85055729010
SN - 2047-9980
VL - 7
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 8
M1 - e007987
ER -