Type of Atrial Fibrillation and Outcomes in Patients With Heart Failure and Reduced Ejection Fraction

Ulrik M. Mogensen, Pardeep S. Jhund, William T. Abraham, Akshay S. Desai, Kenneth Dickstein, Milton Packer, Jean L. Rouleau, Scott D. Solomon, Karl Swedberg, Michael R. Zile, Lars Køber, John J.V. McMurray, PARADIGM-HF and ATMOSPHERE Investigators and Committees

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Background Atrial fibrillation (AF) is common in heart failure (HF), but the outcome by type of AF is largely unknown. Objectives This study investigated outcomes related to type of AF (paroxysmal, persistent or permanent, or new onset) in 2 recent large trials in patients with HF with reduced ejection fraction. Methods The study analyzed patients in the PARADIGM-HF (Prospective comparison of ARNI with ACEI to Determine Impact on Global Mortality and morbidity in Heart Failure) and ATMOSPHERE (Aliskiren Trial to Minimize Outcomes in Patients with Heart Failure) trials. Multivariable Cox regression models were used to estimate hazard ratios (HRs) for outcomes related to AF type. Results Of 15,415 patients, 5,481 (35.6%) had a history of AF at randomization, and of these, 1,645 (30.0%) had paroxysmal AF. Compared with patients without AF, patients with paroxysmal AF at randomization had a higher risk of the primary composite endpoint of cardiovascular death or HF hospitalization (HR: 1.20; 95% confidence interval [CI]: 1.09 to 1.32; p < 0.001), HF hospitalization (HR: 1.34; 95% CI: 1.19 to 1.51; p < 0.001), and stroke (HR: 1.34; 95% CI: 1.02 to 1.76; p = 0.037), whereas the corresponding risks in patients with persistent or permanent AF were not elevated. Neither type of AF was associated with higher mortality. New onset AF was associated with the greatest risk of adverse outcomes: primary endpoint (HR: 2.21; 95% CI: 1.80 to 2.71), HF hospitalization (HR: 2.11; 95% CI: 1.58 to 2.81), stroke (HR: 2.20; 95% CI: 1.25 to 3.88), and all-cause mortality (HR: 2.26; 95% CI: 1.86 to 2.74), all p values < 0.001, compared with patients without AF. Anticoagulants were used less often in patients with paroxysmal (53%) and new onset (16%) AF than in patients with persistent or permanent AF (71%). Conclusions Among HF patients with a history of AF, those with paroxysmal AF were at greater risk of HF hospitalization and stroke than were patients with persistent or permanent AF, underlining the importance of anticoagulant therapy. New onset AF was associated with increased risk of all outcomes. (Prospective comparison of ARNI with ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure [PARADIGM-HF]; NCT01035255) (Aliskiren Trial to Minimize Outcomes in Patients with Heart Failure [ATMOSPHERE]; NCT00853658)

Original languageEnglish (US)
Pages (from-to)2490-2500
Number of pages11
JournalJournal of the American College of Cardiology
Volume70
Issue number20
DOIs
StatePublished - Nov 14 2017

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Atrial Fibrillation
Heart Failure
Confidence Intervals
Hospitalization
Mortality
Stroke
Random Allocation
Anticoagulants
Morbidity
Proportional Hazards Models

Keywords

  • atrial fibrillation
  • heart failure
  • mortality
  • paroxysmal
  • stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Mogensen, U. M., Jhund, P. S., Abraham, W. T., Desai, A. S., Dickstein, K., Packer, M., ... PARADIGM-HF and ATMOSPHERE Investigators and Committees (2017). Type of Atrial Fibrillation and Outcomes in Patients With Heart Failure and Reduced Ejection Fraction. Journal of the American College of Cardiology, 70(20), 2490-2500. https://doi.org/10.1016/j.jacc.2017.09.027

Type of Atrial Fibrillation and Outcomes in Patients With Heart Failure and Reduced Ejection Fraction. / Mogensen, Ulrik M.; Jhund, Pardeep S.; Abraham, William T.; Desai, Akshay S.; Dickstein, Kenneth; Packer, Milton; Rouleau, Jean L.; Solomon, Scott D.; Swedberg, Karl; Zile, Michael R.; Køber, Lars; McMurray, John J.V.; PARADIGM-HF and ATMOSPHERE Investigators and Committees.

In: Journal of the American College of Cardiology, Vol. 70, No. 20, 14.11.2017, p. 2490-2500.

Research output: Contribution to journalArticle

Mogensen, UM, Jhund, PS, Abraham, WT, Desai, AS, Dickstein, K, Packer, M, Rouleau, JL, Solomon, SD, Swedberg, K, Zile, MR, Køber, L, McMurray, JJV & PARADIGM-HF and ATMOSPHERE Investigators and Committees 2017, 'Type of Atrial Fibrillation and Outcomes in Patients With Heart Failure and Reduced Ejection Fraction', Journal of the American College of Cardiology, vol. 70, no. 20, pp. 2490-2500. https://doi.org/10.1016/j.jacc.2017.09.027
Mogensen, Ulrik M. ; Jhund, Pardeep S. ; Abraham, William T. ; Desai, Akshay S. ; Dickstein, Kenneth ; Packer, Milton ; Rouleau, Jean L. ; Solomon, Scott D. ; Swedberg, Karl ; Zile, Michael R. ; Køber, Lars ; McMurray, John J.V. ; PARADIGM-HF and ATMOSPHERE Investigators and Committees. / Type of Atrial Fibrillation and Outcomes in Patients With Heart Failure and Reduced Ejection Fraction. In: Journal of the American College of Cardiology. 2017 ; Vol. 70, No. 20. pp. 2490-2500.
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abstract = "Background Atrial fibrillation (AF) is common in heart failure (HF), but the outcome by type of AF is largely unknown. Objectives This study investigated outcomes related to type of AF (paroxysmal, persistent or permanent, or new onset) in 2 recent large trials in patients with HF with reduced ejection fraction. Methods The study analyzed patients in the PARADIGM-HF (Prospective comparison of ARNI with ACEI to Determine Impact on Global Mortality and morbidity in Heart Failure) and ATMOSPHERE (Aliskiren Trial to Minimize Outcomes in Patients with Heart Failure) trials. Multivariable Cox regression models were used to estimate hazard ratios (HRs) for outcomes related to AF type. Results Of 15,415 patients, 5,481 (35.6{\%}) had a history of AF at randomization, and of these, 1,645 (30.0{\%}) had paroxysmal AF. Compared with patients without AF, patients with paroxysmal AF at randomization had a higher risk of the primary composite endpoint of cardiovascular death or HF hospitalization (HR: 1.20; 95{\%} confidence interval [CI]: 1.09 to 1.32; p < 0.001), HF hospitalization (HR: 1.34; 95{\%} CI: 1.19 to 1.51; p < 0.001), and stroke (HR: 1.34; 95{\%} CI: 1.02 to 1.76; p = 0.037), whereas the corresponding risks in patients with persistent or permanent AF were not elevated. Neither type of AF was associated with higher mortality. New onset AF was associated with the greatest risk of adverse outcomes: primary endpoint (HR: 2.21; 95{\%} CI: 1.80 to 2.71), HF hospitalization (HR: 2.11; 95{\%} CI: 1.58 to 2.81), stroke (HR: 2.20; 95{\%} CI: 1.25 to 3.88), and all-cause mortality (HR: 2.26; 95{\%} CI: 1.86 to 2.74), all p values < 0.001, compared with patients without AF. Anticoagulants were used less often in patients with paroxysmal (53{\%}) and new onset (16{\%}) AF than in patients with persistent or permanent AF (71{\%}). Conclusions Among HF patients with a history of AF, those with paroxysmal AF were at greater risk of HF hospitalization and stroke than were patients with persistent or permanent AF, underlining the importance of anticoagulant therapy. New onset AF was associated with increased risk of all outcomes. (Prospective comparison of ARNI with ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure [PARADIGM-HF]; NCT01035255) (Aliskiren Trial to Minimize Outcomes in Patients with Heart Failure [ATMOSPHERE]; NCT00853658)",
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TY - JOUR

T1 - Type of Atrial Fibrillation and Outcomes in Patients With Heart Failure and Reduced Ejection Fraction

AU - Mogensen, Ulrik M.

AU - Jhund, Pardeep S.

AU - Abraham, William T.

AU - Desai, Akshay S.

AU - Dickstein, Kenneth

AU - Packer, Milton

AU - Rouleau, Jean L.

AU - Solomon, Scott D.

AU - Swedberg, Karl

AU - Zile, Michael R.

AU - Køber, Lars

AU - McMurray, John J.V.

AU - PARADIGM-HF and ATMOSPHERE Investigators and Committees

PY - 2017/11/14

Y1 - 2017/11/14

N2 - Background Atrial fibrillation (AF) is common in heart failure (HF), but the outcome by type of AF is largely unknown. Objectives This study investigated outcomes related to type of AF (paroxysmal, persistent or permanent, or new onset) in 2 recent large trials in patients with HF with reduced ejection fraction. Methods The study analyzed patients in the PARADIGM-HF (Prospective comparison of ARNI with ACEI to Determine Impact on Global Mortality and morbidity in Heart Failure) and ATMOSPHERE (Aliskiren Trial to Minimize Outcomes in Patients with Heart Failure) trials. Multivariable Cox regression models were used to estimate hazard ratios (HRs) for outcomes related to AF type. Results Of 15,415 patients, 5,481 (35.6%) had a history of AF at randomization, and of these, 1,645 (30.0%) had paroxysmal AF. Compared with patients without AF, patients with paroxysmal AF at randomization had a higher risk of the primary composite endpoint of cardiovascular death or HF hospitalization (HR: 1.20; 95% confidence interval [CI]: 1.09 to 1.32; p < 0.001), HF hospitalization (HR: 1.34; 95% CI: 1.19 to 1.51; p < 0.001), and stroke (HR: 1.34; 95% CI: 1.02 to 1.76; p = 0.037), whereas the corresponding risks in patients with persistent or permanent AF were not elevated. Neither type of AF was associated with higher mortality. New onset AF was associated with the greatest risk of adverse outcomes: primary endpoint (HR: 2.21; 95% CI: 1.80 to 2.71), HF hospitalization (HR: 2.11; 95% CI: 1.58 to 2.81), stroke (HR: 2.20; 95% CI: 1.25 to 3.88), and all-cause mortality (HR: 2.26; 95% CI: 1.86 to 2.74), all p values < 0.001, compared with patients without AF. Anticoagulants were used less often in patients with paroxysmal (53%) and new onset (16%) AF than in patients with persistent or permanent AF (71%). Conclusions Among HF patients with a history of AF, those with paroxysmal AF were at greater risk of HF hospitalization and stroke than were patients with persistent or permanent AF, underlining the importance of anticoagulant therapy. New onset AF was associated with increased risk of all outcomes. (Prospective comparison of ARNI with ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure [PARADIGM-HF]; NCT01035255) (Aliskiren Trial to Minimize Outcomes in Patients with Heart Failure [ATMOSPHERE]; NCT00853658)

AB - Background Atrial fibrillation (AF) is common in heart failure (HF), but the outcome by type of AF is largely unknown. Objectives This study investigated outcomes related to type of AF (paroxysmal, persistent or permanent, or new onset) in 2 recent large trials in patients with HF with reduced ejection fraction. Methods The study analyzed patients in the PARADIGM-HF (Prospective comparison of ARNI with ACEI to Determine Impact on Global Mortality and morbidity in Heart Failure) and ATMOSPHERE (Aliskiren Trial to Minimize Outcomes in Patients with Heart Failure) trials. Multivariable Cox regression models were used to estimate hazard ratios (HRs) for outcomes related to AF type. Results Of 15,415 patients, 5,481 (35.6%) had a history of AF at randomization, and of these, 1,645 (30.0%) had paroxysmal AF. Compared with patients without AF, patients with paroxysmal AF at randomization had a higher risk of the primary composite endpoint of cardiovascular death or HF hospitalization (HR: 1.20; 95% confidence interval [CI]: 1.09 to 1.32; p < 0.001), HF hospitalization (HR: 1.34; 95% CI: 1.19 to 1.51; p < 0.001), and stroke (HR: 1.34; 95% CI: 1.02 to 1.76; p = 0.037), whereas the corresponding risks in patients with persistent or permanent AF were not elevated. Neither type of AF was associated with higher mortality. New onset AF was associated with the greatest risk of adverse outcomes: primary endpoint (HR: 2.21; 95% CI: 1.80 to 2.71), HF hospitalization (HR: 2.11; 95% CI: 1.58 to 2.81), stroke (HR: 2.20; 95% CI: 1.25 to 3.88), and all-cause mortality (HR: 2.26; 95% CI: 1.86 to 2.74), all p values < 0.001, compared with patients without AF. Anticoagulants were used less often in patients with paroxysmal (53%) and new onset (16%) AF than in patients with persistent or permanent AF (71%). Conclusions Among HF patients with a history of AF, those with paroxysmal AF were at greater risk of HF hospitalization and stroke than were patients with persistent or permanent AF, underlining the importance of anticoagulant therapy. New onset AF was associated with increased risk of all outcomes. (Prospective comparison of ARNI with ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure [PARADIGM-HF]; NCT01035255) (Aliskiren Trial to Minimize Outcomes in Patients with Heart Failure [ATMOSPHERE]; NCT00853658)

KW - atrial fibrillation

KW - heart failure

KW - mortality

KW - paroxysmal

KW - stroke

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