Cardiology Xagena

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Heart failure in patients with atrial fibrillation: 1-year mortality and morbidity remain high, despite a high prevalence of oral anticoagulant use

The purpose of the study was to describe the associated baseline features of atrial fibrillation patients with heart failure ( HF ) with reduced and preserved ejection fraction ( HFrEF and HFpEF ).
Secondly, researchers assessed symptomatic status and their clinical correlates, and examined independent predictors for heart failure at the 1-year follow-up period.

A survey of European cardiologists from nine countries, participating in the EURObservational Research Programme Pilot survey on Atrial Fibrillation ( EORP-AF Pilot ), was carried out.

Of the whole cohort of 2972 patients, 1411 ( 47.5% ) had a diagnosis of heart failure. Of the atrial fibrillation patients with heart failure, oral anticoagulants were prescribed to 82.1% and antiarrhythmic drugs in 36.7%.

Independent predictors of HFpEF were high body mass index, high heart rate, high systolic blood pressure, low diastolic blood pressure, high CHA2DS2-VASc score, and absence of chronic kidney disease, sleep apnoea, or ischaemic cardiomyopathy.

On multivariate stepwise regression analysis, independent predictors of the development of heart failure were mode of atrial fibrillation presentation, diuretic use, prior heart failure, chronic obstructive pulmonary disease ( COPD ), and valvular disease.

At 1 year, heart failure was associated with a greater risk of all-cause mortality ( log-rank test, P less than 0.001 ).
When HFrEF was compared with HFpEF at 1 year, crude rates were significant for the composite endpoint of stroke / thrombo-embolism / transient ischaemic attack and death ( 15.9% vs 11.1%, P = 0.043 ).

In conclusion, the study provides insights into the clinical characteristics and outcomes in atrial fibrillation patients with heart failure, who were managed by European cardiologists.
Despite a high prevalence of oral anticoagulant use, 1-year mortality and morbidity remained high in atrial fibrillation patients with heart failure, whether HFrEF or HFpEF.
Such patients require a holistic approach to cardiovascular risk management. ( Xagena )

Lip GY et al, Eur J Heart Fail 2015;17:570-582