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Mapelli M, Mattavelli I, Salvioni E, Capra N, Bonomi A, Cattadori G, Pezzuto B, Campodonico J, Piotti A, Nava A, Piepoli M, Magrì D, Paolillo S, Corrà U, Raimondo R, Lagioia R, Vignati C, Badagliacca R, Perrone Filardi P, Senni M, Correale M, Cicoira M, Metra M, Guazzi M, Limongelli G, Parati G, De Martino F, Bandera F, Bussotti M, Re F, Lombardi CM, Scardovi AB, Sciomer S, Passantino A, Emdin M, Santolamazza C, Perna E, Passino C, Sinagra G, Agostoni P. Exploring the Prognostic Performance of MECKI Score in Heart Failure Patients with Non-Valvular Atrial Fibrillation Treated with Edoxaban. J Clin Med 2023; 13:94. [PMID: 38202101 PMCID: PMC10780296 DOI: 10.3390/jcm13010094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 11/27/2023] [Accepted: 12/06/2023] [Indexed: 01/12/2024] Open
Abstract
INTRODUCTION Risk stratification in heart failure (HF) is essential for clinical and therapeutic management. The Metabolic Exercise test data combined with Cardiac and Kidney Indexes (MECKI) score is a validated prognostic model for assessing cardiovascular risk in HF patients with reduced ejection fraction (HFrEF). From the validation of the score, the prevalence of HF patients treated with direct oral anticoagulants (DOACs), such as edoxaban, for non-valvular atrial fibrillation (NVAF) has been increasing in recent years. This study aims to evaluate the reliability of the MECKI score in HFrEF patients treated with edoxaban for NVAF. MATERIALS AND METHODS This study included consecutive outpatients with HF and NVAF treated with edoxaban (n = 83) who underwent a cardiopulmonary exercise test (CPET). They were matched by propensity score with a retrospective group of HFrEF patients with NVAF treated with vitamin K antagonists (VKAs) from the MECKI score registry (n = 844). The study endpoint was the risk of cardiovascular mortality, urgent heart transplantation, or Left Ventricle Assist Device (LVAD) implantation. RESULTS Edoxaban patients were treated with a more optimized HF therapy and had different clinical characteristics, with a similar MECKI score. After propensity score, 77 patients treated with edoxaban were successfully matched with the MECKI-VKA control cohort. In both groups, MECKI accurately predicted the composite endpoint with similar area under the curves (AUC = 0.757 vs. 0.829 in the MECKI-VKA vs. edoxaban-treated group, respectively, p = 0.452). The two populations' survival appeared non-significantly different at the 2-year follow-up. CONCLUSIONS this study confirms the prognostic accuracy of the MECKI score in HFrEF patients with NVAF treated with edoxaban, showing improved predictive power compared to VKA-treated patients.
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Affiliation(s)
- Massimo Mapelli
- Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy; (M.M.); (I.M.); (E.S.); (N.C.); (A.B.); (B.P.); (J.C.); (A.P.); (C.V.); (P.A.)
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, 20122 Milan, Italy
| | - Irene Mattavelli
- Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy; (M.M.); (I.M.); (E.S.); (N.C.); (A.B.); (B.P.); (J.C.); (A.P.); (C.V.); (P.A.)
| | - Elisabetta Salvioni
- Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy; (M.M.); (I.M.); (E.S.); (N.C.); (A.B.); (B.P.); (J.C.); (A.P.); (C.V.); (P.A.)
| | - Nicolò Capra
- Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy; (M.M.); (I.M.); (E.S.); (N.C.); (A.B.); (B.P.); (J.C.); (A.P.); (C.V.); (P.A.)
| | - Alice Bonomi
- Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy; (M.M.); (I.M.); (E.S.); (N.C.); (A.B.); (B.P.); (J.C.); (A.P.); (C.V.); (P.A.)
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, 20122 Milan, Italy
| | - Gaia Cattadori
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, 20122 Milan, Italy
- Unità Operativa Cardiologia Riabilitativa, IRCCS Multimedica, 20138 Milan, Italy
| | - Beatrice Pezzuto
- Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy; (M.M.); (I.M.); (E.S.); (N.C.); (A.B.); (B.P.); (J.C.); (A.P.); (C.V.); (P.A.)
| | - Jeness Campodonico
- Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy; (M.M.); (I.M.); (E.S.); (N.C.); (A.B.); (B.P.); (J.C.); (A.P.); (C.V.); (P.A.)
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, 20122 Milan, Italy
| | - Arianna Piotti
- Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy; (M.M.); (I.M.); (E.S.); (N.C.); (A.B.); (B.P.); (J.C.); (A.P.); (C.V.); (P.A.)
| | | | - Massimo Piepoli
- Clinical Cardiology, IRCCS, Policlinico San Donato, 20097 San Donato Milanese, Italy;
- Department Biomedical Sciences for Health, University of Milan, 20122 Milan, Italy;
| | - Damiano Magrì
- Department of Clinical and Molecular Medicine, Azienda Ospedaliera Sant’Andrea, “Sapienza” Università degli Studi di Roma, 00185 Rome, Italy;
| | - Stefania Paolillo
- IRCCS SDN, Istituto di Ricerca, 80143 Napoli, Italy;
- Department of Advanced Biomedical Sciences, “Federico II” University, 80138 Napoli, Italy;
| | - Ugo Corrà
- Cardiology Department, Istituti Clinici Scientifici Maugeri, IRCCS, Veruno Institute, 28010 Veruno, Italy;
| | - Rosa Raimondo
- Divisione di Cardiologia Riabilitativa, Istituti Clinici Scientifici Maugeri, IRCCS, 21049 Tradate, Italy;
| | - Rocco Lagioia
- UOC Cardiologia di Riabilitativa, Mater Dei Hospital, 70125 Bari, Italy;
| | - Carlo Vignati
- Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy; (M.M.); (I.M.); (E.S.); (N.C.); (A.B.); (B.P.); (J.C.); (A.P.); (C.V.); (P.A.)
| | - Roberto Badagliacca
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, “Sapienza”, Rome University, 00185 Rome, Italy; (R.B.); (S.S.)
| | | | - Michele Senni
- Cardiology Unit, Cardiovascular Department, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy;
| | - Michele Correale
- Department of Cardiology, University of Foggia, 71122 Foggia, Italy;
| | | | - Marco Metra
- Institute of Cardiology, Department of Medical and Surgical Specialities, Radiological Sciences, and Public Health, University of Brescia, 25121 Brescia, Italy; (M.M.); (C.M.L.)
| | - Marco Guazzi
- Dipartimento di Scienze Biomediche per la Salute, Ospedale San Paolo, Università Degli Studi di Milano, 20122 Milan, Italy;
| | - Giuseppe Limongelli
- Cardiologia SUN, Ospedale Monaldi (Azienda dei Colli), Seconda Università di Napoli, 80138 Napoli, Italy;
| | - Gianfranco Parati
- Istituto Auxologico Italiano, IRCCS, 20138 Milan, Italy;
- Department of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
| | - Fabiana De Martino
- Unità Funzionale di Cardiologia, Casa di Cura Tortorella, 84124 Salerno, Italy;
| | - Francesco Bandera
- Department Biomedical Sciences for Health, University of Milan, 20122 Milan, Italy;
- Cardiology University Department, IRCCS Policlinico San Donato, 20097 Milan, Italy
| | - Maurizio Bussotti
- Cardiac Rehabilitation Unit, Istituti Clinici Scientifici Maugeri, IRCCS, Scientific Institute of Milan, 20138 Milan, Italy;
| | - Federica Re
- Cardiology Division, Cardiac Arrhythmia Center and Cardiomyopathies Unit, San Camillo-Forlanini Hospital, 00152 Rome, Italy;
| | - Carlo M. Lombardi
- Institute of Cardiology, Department of Medical and Surgical Specialities, Radiological Sciences, and Public Health, University of Brescia, 25121 Brescia, Italy; (M.M.); (C.M.L.)
| | | | - Susanna Sciomer
- Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, “Sapienza”, Rome University, 00185 Rome, Italy; (R.B.); (S.S.)
| | - Andrea Passantino
- Division of Cardiology, Istituti Clinici Scientifici Maugeri, IRCCS, Institute of Bari, 70124 Bari, Italy;
| | - Michele Emdin
- Health Science Interdisciplinary Center, Scuola Superiore Sant’Anna, 56127 Pisa, Italy; (M.E.); (C.P.)
- Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy
| | - Caterina Santolamazza
- Dipartimento Cardio-Toraco-Vascolare, Ospedale Cà Granda-A.O. Niguarda, 20162 Milan, Italy; (C.S.); (E.P.)
| | - Enrico Perna
- Dipartimento Cardio-Toraco-Vascolare, Ospedale Cà Granda-A.O. Niguarda, 20162 Milan, Italy; (C.S.); (E.P.)
| | - Claudio Passino
- Health Science Interdisciplinary Center, Scuola Superiore Sant’Anna, 56127 Pisa, Italy; (M.E.); (C.P.)
| | - Gianfranco Sinagra
- Cardiovascular Department, “Azienda Sanitaria Universitaria Giuliano-Isontina”, 34100 Trieste, Italy;
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy; (M.M.); (I.M.); (E.S.); (N.C.); (A.B.); (B.P.); (J.C.); (A.P.); (C.V.); (P.A.)
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, 20122 Milan, Italy
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Scarano Pereira JP, Owen E, Martinino A, Akmal K, Abouelazayem M, Graham Y, Weiner S, Sakran N, Dekker LR, Parmar C, Pouwels S. Epicardial adipose tissue, obesity and the occurrence of atrial fibrillation: an overview of pathophysiology and treatment methods. Expert Rev Cardiovasc Ther 2022; 20:307-322. [PMID: 35443854 DOI: 10.1080/14779072.2022.2067144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Obesity is a chronic disease, which has significant health consequences and is a staggering burden to health care systems. Obesity can have harmful effects on the cardiovascular system, including heart failure, hypertension, coronary heart disease, and atrial fibrillation (AF). One of the possible substrates might be epicardial adipose tissue (EAT), which can be the link between AF and obesity. EAT is a fat deposit located between the myocardium and the visceral pericardium. Numerous studies have demonstrated that EAT plays a pivotal role in this relationship regarding atrial fibrillation. AREAS COVERED This review will focus on the role of obesity and the occurrence of atrial fibrillation (AF) and examine the connection between these and epicardial adipose tissue (EAT). The first part of this review will explain the pathophysiology of EAT and its association with the occurrence of AF. Secondly, we will review bariatric and metabolic surgery and its effects on EAT and AF. EXPERT COMMENTARY In this review, the epidemiology, pathophysiology, and treatments methods of AF are explained. Secondly the effects on EAT were elucidated. Due to the complex pathophysiological link between EAT, AF, and obesity, it is still uncertain which treatment strategy is superior.
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Affiliation(s)
| | - Eloise Owen
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | | | - Kiran Akmal
- Faculty of Medicine, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Mohamed Abouelazayem
- Department of Surgery, Royal Free London Hospitals NHS Foundation, London, United Kingdom
| | - Yitka Graham
- Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, United Kingdom.,Facultad de Psucologia, Universidad Anahuac Mexico, Mexico City, Mexico
| | - Sylvia Weiner
- Department of Bariatric and Metabolic Surgery, Krankenhaus Nordwest, Frankfurt am Main, Germany
| | - Nasser Sakran
- Department of Surgery, Holy Family Hospital, Nazareth, Israel.,Azrieli, Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Lukas R Dekker
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands
| | - Chetan Parmar
- Department of Surgery, Whittington Health NHS Trust, London, United Kingdom
| | - Sjaak Pouwels
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
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Brady PF, Chua W, Nehaj F, Connolly DL, Khashaba A, Purmah YJV, Ul-Qamar MJ, Thomas MR, Varma C, Schnabel RB, Zeller T, Fabritz L, Kirchhof PF. Interactions Between Atrial Fibrillation and Natriuretic Peptide in Predicting Heart Failure Hospitalization or Cardiovascular Death. J Am Heart Assoc 2022; 11:e022833. [PMID: 35112889 PMCID: PMC9245805 DOI: 10.1161/jaha.121.022833] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Natriuretic peptides are routinely quantified to diagnose heart failure (HF). Their concentrations are also elevated in atrial fibrillation (AF). To clarify their value in predicting future cardiovascular events, we measured natriuretic peptides in unselected patients with cardiovascular conditions and related their concentrations to AF and HF status and outcomes. Methods and Results Consecutive patients with cardiovascular conditions presenting to a large teaching hospital underwent clinical assessment, 7-day ECG monitoring, and echocardiography to diagnose AF and HF. NT-proBNP (N-terminal pro-B-type natriuretic peptide) was centrally quantified. Based on a literature review, four NT-proBNP groups were defined (<300, 300-999, 1000-1999, and ≥2000 pg/mL). Clinical characteristics and NT-proBNP concentrations were related to HF hospitalization or cardiovascular death. Follow-up data were available in 1616 of 1621 patients (99.7%) and analysis performed at 2.5 years (median age, 70 [interquartile range, 60-78] years; 40% women). HF hospitalization or cardiovascular death increased from 36 of 488 (3.2/100 person-years) in patients with neither AF nor HF, to 55 of 354 (7.1/100 person-years) in patients with AF only, 92 of 369 (12.1/100 person-years) in patients with HF only, and 128 of 405 (17.7/100 person-years) in patients with AF plus HF (P<0.001). Higher NT-proBNP concentrations predicted the outcome in patients with AF only (C-statistic, 0.82; 95% CI, 0.77-0.86; P <0.001) and in other phenotype groups (C-statistic in AF plus HF, 0.66; [95% CI, 0.61-0.70]; P <0.001). Conclusions Elevated NT-proBNP concentrations predict future HF events in patients with AF irrespective of the presence of HF, encouraging routine quantification of NT-proBNP in the assessment of patients with AF.
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Affiliation(s)
- Paul F Brady
- Institute of Cardiovascular Sciences College of Medical and Dental Sciences University of Birmingham Birmingham UK.,Department of Cardiology Sandwell and West Birmingham NHS Trust Birmingham UK.,Department of Cardiology University Hospitals Birmingham NHS Foundation Trust Birmingham UK
| | - Winnie Chua
- Institute of Cardiovascular Sciences College of Medical and Dental Sciences University of Birmingham Birmingham UK
| | - Frantisek Nehaj
- Institute of Cardiovascular Sciences College of Medical and Dental Sciences University of Birmingham Birmingham UK.,Department of Cardiology Sandwell and West Birmingham NHS Trust Birmingham UK.,Department of Cardiac Electrophysiology and Pacing National Cardiovascular Institute Bratislava Slovakia
| | - Derek L Connolly
- Institute of Cardiovascular Sciences College of Medical and Dental Sciences University of Birmingham Birmingham UK.,Department of Cardiology Sandwell and West Birmingham NHS Trust Birmingham UK
| | - Alya Khashaba
- Institute of Cardiovascular Sciences College of Medical and Dental Sciences University of Birmingham Birmingham UK
| | - Yanish J V Purmah
- Institute of Cardiovascular Sciences College of Medical and Dental Sciences University of Birmingham Birmingham UK.,Department of Cardiology Sandwell and West Birmingham NHS Trust Birmingham UK
| | - Muhammad J Ul-Qamar
- Institute of Cardiovascular Sciences College of Medical and Dental Sciences University of Birmingham Birmingham UK.,Department of Cardiology Sandwell and West Birmingham NHS Trust Birmingham UK
| | - Mark R Thomas
- Institute of Cardiovascular Sciences College of Medical and Dental Sciences University of Birmingham Birmingham UK.,Department of Cardiology University Hospitals Birmingham NHS Foundation Trust Birmingham UK
| | - Chetan Varma
- Institute of Cardiovascular Sciences College of Medical and Dental Sciences University of Birmingham Birmingham UK.,Department of Cardiology Sandwell and West Birmingham NHS Trust Birmingham UK
| | - Renate B Schnabel
- Department of Cardiology University Heart and Vascular Center Hamburg, University Medical Center Hamburg Eppendorf Hamburg Germany.,German Center for Cardiovascular Research (DZHK)partner site Hamburg/Kiel/Lübeck Germany
| | - Tanja Zeller
- Department of Cardiology University Heart and Vascular Center Hamburg, University Medical Center Hamburg Eppendorf Hamburg Germany.,German Center for Cardiovascular Research (DZHK)partner site Hamburg/Kiel/Lübeck Germany
| | - Larissa Fabritz
- Institute of Cardiovascular Sciences College of Medical and Dental Sciences University of Birmingham Birmingham UK.,Department of Cardiology University Hospitals Birmingham NHS Foundation Trust Birmingham UK.,Department of Cardiology University Heart and Vascular Center Hamburg, University Medical Center Hamburg Eppendorf Hamburg Germany.,German Center for Cardiovascular Research (DZHK)partner site Hamburg/Kiel/Lübeck Germany
| | - Paulus F Kirchhof
- Institute of Cardiovascular Sciences College of Medical and Dental Sciences University of Birmingham Birmingham UK.,Department of Cardiology University Heart and Vascular Center Hamburg, University Medical Center Hamburg Eppendorf Hamburg Germany.,German Center for Cardiovascular Research (DZHK)partner site Hamburg/Kiel/Lübeck Germany
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Shiga T. OUP accepted manuscript. Eur Heart J Suppl 2022; 24:D11-D21. [PMID: 35706898 PMCID: PMC9190747 DOI: 10.1093/eurheartjsupp/suac023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Atrial tachyarrhythmias often occur in patients with worsening heart failure (HF), and the development of atrial tachyarrhythmias in acute decompensated HF (ADHF) causes an uncontrolled heart rate (HR) and leads to further exacerbation of HF and persistence of a decompensated HF state. Landiolol, a short-acting intravenous beta-1 blocker, shows very high cardiac beta-1 selectivity and has a very short elimination half-life of approximately 4 min. As shown in several reports, the benefit of intravenous landiolol is that it lowers the ventricular rate early after the start of use without markedly deteriorating haemodynamics. After the cardiac status is stabilized by rapid control of HR, subsequent basic HF pharmacotherapy and rhythm control therapies will be effective for improving outcomes. Because of the pharmacokinetic properties of landiolol, if the patient suffers an adverse reaction such as hypotension or bradycardia, such effects can be quickly reversed by tapering the dose or discontinuing use altogether. Based on several clinical studies, this review discusses the efficacy, safety and role of intravenous landiolol in acute HR control in patients with atrial tachyarrhythmias and ADHF.
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Affiliation(s)
- Tsuyoshi Shiga
- Corresponding author. Tel: +81 3 3433 1111, Fax: +81 3 5472 6466,
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5
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Abstract
Rate and rhythm control are still considered equivalent strategies for symptom control using the Atrial Fibrillation Better Care algorithm recommended by the recent atrial fibrillation guideline. In acute situations or critically ill patients, a personalized approach should be used for rapid rhythm or rate control. Even though electrical cardioversion is generally indicated in haemodynamically unstable patients or for rapid effective rhythm control in critically ill patients, this is not always possible due to the high percentage of failure or relapses in such patients. Rate control remains the background therapy for all these patients, and often rapid rate control is mandatory. Short and rapid-onset-acting beta-blockers are the most suitable drugs for acute rate control. Esmolol was the classical example; however, landiolol a newer very selective beta-blocker, recently included in the European atrial fibrillation guideline, has a more favourable pharmacokinetic and pharmacodynamic profile with less haemodynamic interference and is better appropriate for critically ill patients.
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Hesselson A, Hesselson H. Catheter Ablation for Persistent Atrial Fibrillation in Class IV Systolic Heart Failure: A Single-Center Case Series. J Atr Fibrillation 2021; 13:20200428. [PMID: 34950345 DOI: 10.4022/jafib.20200428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 01/21/2021] [Accepted: 01/28/2021] [Indexed: 11/10/2022]
Abstract
Questions remain as to how aggressively catheter ablation for atrial fibrillation may be applied to patients with advanced systolic congestive heart failure, owing to a historic under-representation in multicenter clinical ablation trials. We sought to describe the experience of catheter ablation for persistent atrial fibrillation in Class IV systolic heart failure patients at our institution. All Class IV systolic heart failure patients (left ventricular assist device patients excluded) between 2017 and 2020 referred for radiofrequency ablation were included. Out of 10 patients, 7 agreed to proceed, had restoration of normal sinus rhythm upon completion of the catheter ablation procedure, and of which five (71%) remain in normal rhythm at a mean follow-up of 23 months. Catheter ablation for atrial fibrillation in patients with Class IV chronic systolic heart failure, even on advanced heart failure therapies, is feasible, and can improve heart failure status with maintenance of NSR.
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Affiliation(s)
- Aaron Hesselson
- University of Kentucky Division of Cardiovascular Medicine, 900 South Limestone Street, CTW 305D, Lexington, KY 40536
| | - Heather Hesselson
- University of Kentucky, College of Pharmacy, 789 S Limestone, Lexington, KY 40508
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Meta-Analysis of Catheter Ablation versus Medical Therapy for Heart Failure Complicated with Atrial Fibrillation. Cardiol Res Pract 2021; 2021:7245390. [PMID: 34912577 PMCID: PMC8668366 DOI: 10.1155/2021/7245390] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 10/28/2021] [Accepted: 11/23/2021] [Indexed: 11/17/2022] Open
Abstract
Objective To compare the efficacy of catheter ablation and medical therapy in patients with heart failure and atrial fibrillation. Methods We searched randomized controlled trials comparing catheter ablation versus medical therapy for heart failure and atrial fibrillation through PubMed, MEDLINE, Embase, Cochrane Clinical Trials Database, Web of Science, and China National Knowledge Infrastructure. Articles were investigated for their methodological quality using the Cochrane Collaboration risk of the bias assessment tool. Forest plots, funnel plots, and sensitivity analysis were also performed on the included articles. Results were expressed as risk ratio (RR) and mean difference (MD) with 95% confidence intervals. Results Nine (9) studies were included in this study with 1131 patients. Meta-analysis showed a reduction in all-cause mortality from catheter ablation compared with medical therapy (RR = 0.53, 95% CI = 0.37 to 0.76; P=0.0007) and improved left ventricular ejection fraction (LVEF) (MD = 6.45, 95% CI = 3.49 to 9.41; P < 0.0001), 6-minute walking time (6MWT) (MD = 28.32, 95% CI = 17.77 to 38.87; P < 0.0001), and Minnesota Living with Heart Failure Questionnaire (MLHFQ) score (MD = 8.19, 95% CI = 0.30 to 16.08; P=0.04). Conclusion Catheter ablation had a better improvement than medical treatment in left ventricular ejection fraction, cardiac function, and exercise ability for atrial fibrillation and heart failure patients.
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8
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Temporal Relationship between Atrial Fibrillation and Heart Failure Development Analysis from a Nationwide Database. J Clin Med 2021; 10:jcm10215101. [PMID: 34768619 PMCID: PMC8585083 DOI: 10.3390/jcm10215101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 10/25/2021] [Accepted: 10/28/2021] [Indexed: 01/04/2023] Open
Abstract
Background Atrial fibrillation (AF) and heart failure (HF) often co-exist and are closely intertwined, each condition worsening the other. The temporal relationships between these two disorders have not yet been fully explored. We aimed to address the outcomes of patients hospitalized with HF and AF based on the chronology of the onset of the two disorders. Methods From the administrative database for the whole French population, we identified 1,349,638 patients diagnosed with both AF and HF between 2010 and 2018; 956,086 of these AF patients developed HF first (prevalent HF), and 393,552 developed HF after AF (incident HF). The outcome analysis (all-cause death, cardiovascular (CV) death, ischemic stroke or hospitalization for HF) was performed with follow-up starting at the time of last event between AF or HF in the whole cohort and in 427,848 propensity score-matched patients. Results During follow-up (mean follow-up 1.6 ± 1.9 year), matched patients with prevalent HF had a higher risk of all-cause death (21.6 vs. 19.3%/year, hazard ratio (HR) 1.10, 95% CI 1.08–1.11), CV death (7.7 vs. 6.5%/year, HR 1.14, 95% CI 1.12–1.16) as well as re-hospitalization for HF (19.4 vs. 13.2%/year, HR 1.44, 95% CI 1.41–1.46) than those with incident HF. The risk for ischemic stroke was lower in prevalent HF than in incident HF (1.2 vs. 2.4%/year, HR 0.50, 95% CI 0.48–0.52). Conclusions We identified two distinct clinical entities: patients in whom HF preceded AF (prevalent HF) had higher mortality and higher risk of re-hospitalization for HF.
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Bernard ML, Benn F, Williams CM, Hiltbold AE, Rogers PA, Polin GM, Khatib S, Al-Khatib SM, Morin DP. The role of atrial fibrillation catheter ablation in patients with heart failure. Prog Cardiovasc Dis 2021; 66:80-85. [PMID: 34332663 DOI: 10.1016/j.pcad.2021.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Atrial Fibrillation (AF) and heart failure (HF) with reduced ejection fraction (HFrEF) frequently coexist, resulting in significant morbidity and mortality. Therapeutic options for patients with AF and HFrEF are limited due to few antiarrhythmic drug (AAD) choices and historically equivocal effects of procedural interventions on mortality. However, recent randomized trials examining catheter ablation (CA) in AF patients with HFrEF have shown a beneficial effect on arrhythmic burden and HF symptoms, as well as an improvement in mortality. This review focuses on the role of CA for AF patients with HFrEF.
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10
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Romiti GF, Corica B, Pipitone E, Vitolo M, Raparelli V, Basili S, Boriani G, Harari S, Lip GYH, Proietti M. Prevalence, management and impact of chronic obstructive pulmonary disease in atrial fibrillation: a systematic review and meta-analysis of 4,200,000 patients. Eur Heart J 2021; 42:3541-3554. [PMID: 34333599 DOI: 10.1093/eurheartj/ehab453] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 04/07/2021] [Accepted: 06/29/2021] [Indexed: 11/12/2022] Open
Abstract
AIM Prevalence of chronic obstructive pulmonary disease (COPD) in atrial fibrillation (AF) patients is unclear, and its association with adverse outcomes is often overlooked. Our aim was to estimate the prevalence of COPD, its impact on clinical management and outcomes in patients with AF, and the impact of beta-blockers (BBs) on outcomes in patients with COPD. METHODS AND RESULTS A systematic review and meta-analysis was conducted according to international guidelines. All studies reporting the prevalence of COPD in AF patients were included. Data on comorbidities, BBs and oral anticoagulant prescription, and outcomes (all-cause death, cardiovascular (CV) death, ischaemic stroke, major bleeding) were compared according to COPD and BB status. Among 46 studies, pooled prevalence of COPD was 13% [95% confidence intervals (CI) 10-16%, 95% prediction interval 2-47%]. COPD was associated with higher prevalence of comorbidities, higher CHA2DS2-VASc score and lower BB prescription [odds ratio (OR) 0.77, 95% CI 0.61-0.98]. COPD was associated with higher risk of all-cause death (OR 2.22, 95% CI 1.93-2.55), CV death (OR 1.84, 95% CI 1.39-2.43), and major bleeding (OR 1.45, 95% CI 1.17-1.80); no significant differences in outcomes were observed according to BB use in AF patients with COPD. CONCLUSION COPD is common in AF, being found in 13% of patients, and is associated with increased burden of comorbidities, differential management, and worse outcomes, with more than a two-fold higher risk of all-cause death and increased risk of CV death and major bleeding. Therapy with BBs does not increase the risk of adverse outcomes in patients with AF and COPD.
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Affiliation(s)
- Giulio Francesco Romiti
- Department of Translational and Precision Medicine, Sapienza-University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Bernadette Corica
- Department of Translational and Precision Medicine, Sapienza-University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Eugenia Pipitone
- Ospedale Regionale "Beata Vergine", Via Turconi 23, 6850 Mendrisio, Switzerland
| | - Marco Vitolo
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, via Giuseppe Campi 287, 41125, Modena, Italy.,Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Brownlow Hill, L69 7TX Liverpool, UK.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, via Giuseppe Campi 287, 41125 Modena, Italy
| | - Valeria Raparelli
- Department of Translational Medicine, University of Ferrara, Via Luigi Borsari, 46, 44121 Italy.,University of Alberta, Faculty of Nursing, 11405-87 Avenue, T6G 1C9 Edmonton, Alberta, Canada
| | - Stefania Basili
- Department of Translational and Precision Medicine, Sapienza-University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, via Giuseppe Campi 287, 41125, Modena, Italy
| | - Sergio Harari
- U.O. di Pneumologia e Terapia Semi-Intensiva Respiratoria-Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare, Ospedale San Giuseppe-MultiMedica IRCCS, Via San Vittore 12, 20123 Milan, Italy.,Department of Medical Sciences, San Giuseppe Hospital MultiMedica IRCCS, Via San Vittore 12, 20123 Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Via della Commenda 19, 20122 Milan, Italy
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Brownlow Hill, L69 7TX Liverpool, UK.,Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, 9000 Aalborg, Denmark
| | - Marco Proietti
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Brownlow Hill, L69 7TX Liverpool, UK.,Department of Clinical Sciences and Community Health, University of Milan, Via della Commenda 19, 20122 Milan, Italy.,Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Via Camaldoli 64, Milano 20138, Italy
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11
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Optimizing prognosis in atrial fibrillation: A call to action in Portugal. Rev Port Cardiol 2021; 40:595-605. [PMID: 34392904 DOI: 10.1016/j.repce.2020.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 07/10/2020] [Indexed: 11/22/2022] Open
Abstract
Atrial fibrillation (AF), the most common arrhythmia in the adult population worldwide, represents a significant burden in terms of cardiovascular mortality and morbidity and has repercussions on health economics. Oral anticoagulation (OAC) is key to stroke prevention in AF and, in recent years, results from landmark clinical trials of non-vitamin K oral anticoagulants (NOAC) have triggered a paradigm shift in thrombocardiology. Despite these advances, there is still a significant residual vascular risk associated with silent AF, bleeding, premature sudden death and heart failure. The authors review AF epidemiologic data, the importance of new tools for early AF detection, the current role of catheter ablation for rhythm control in AF, the state-of-the-art in periprocedural OAC, the optimal management of major bleeding, the causes of residual premature death and future strategies for improvements in AF prognosis.
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12
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Optimizing prognosis in atrial fibrillation: A call to action in Portugal. Rev Port Cardiol 2021. [DOI: 10.1016/j.repc.2020.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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13
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Faragli A, Tano GD, Carlini CD, Nassiacos D, Gori M, Confortola G, Lo Muzio FP, Rapis K, Abawi D, Post H, Kelle S, Pieske B, Alogna A, Campana C. In-hospital Heart Rate Reduction With Beta Blockers and Ivabradine Early After Recovery in Patients With Acute Decompensated Heart Failure Reduces Short-Term Mortality and Rehospitalization. Front Cardiovasc Med 2021; 8:665202. [PMID: 34395550 PMCID: PMC8363305 DOI: 10.3389/fcvm.2021.665202] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 05/31/2021] [Indexed: 11/21/2022] Open
Abstract
Objective: In the past years, heart rate (HR) has emerged as a highly relevant modifiable risk factor for heart failure (HF) patients. However, most of the clinical trials so far evaluated the role of HR in stable chronic HF cohorts. The aim of this multi-center, prospective observational study was to assess the association between HR and therapy with HR modulators (beta blockers, ivabradine, or a combination of ivabradine and beta blockers) at hospital discharge with patients' cardiovascular mortality and re-hospitalization at 6 months in acutely decompensated HF patients. Materials and Methods: We recruited 289 HF patients discharged alive after admission for HF decompensation from 10 centers in northern Italy over 9 months (from April 2017 to January 2018). The primary endpoint was the combination of cardiovascular mortality or re-hospitalizations for HF at 6 months. Results: At 6 months after discharge, 64 patients were readmitted (32%), and 39 patients died (16%). Multivariate analysis showed that HR at discharge ≥ 90 bpm (OR = 8.47; p = 0.016) independently predicted cardiovascular mortality, while therapy with beta blockers at discharge was found to reduce the risk of the composite endpoint. In patients receiving HR modulators the event rates for the composite endpoint, all-cause mortality, and cardiovascular mortality were lower than in patients not receiving HR modulators. Conclusions: Heart rate at discharge ≥90 bpm predicts cardiovascular mortality, while therapy with beta blockers is negatively associated with the composite endpoint of cardiovascular mortality and hospitalization at 6 months in acutely decompensated HF patients. Patients receiving a HR modulation therapy at hospital discharge showed the lowest rate of cardiovascular mortality and re-hospitalization.
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Affiliation(s)
- Alessandro Faragli
- Department of Internal Medicine and Cardiology, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.,Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Giuseppe Di Tano
- Department of Cardiology Ospedale Maggiore, ASST Cremona, Cremona, Italy
| | | | - Daniel Nassiacos
- Department of Cardiology, Ospedale di Circolo, ASST Valle Olona, Saronno VA, Italy
| | - Mauro Gori
- Department of Cardiology, ASST Ospedale Papa Giovanni XXXIII, Bergamo, Italy
| | - Giada Confortola
- Department of Internal Medicine and Cardiology, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Francesco Paolo Lo Muzio
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, Verona, Italy.,Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Konstantinos Rapis
- Department of Internal Medicine and Cardiology, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Dawud Abawi
- Department of Internal Medicine and Cardiology, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Heiner Post
- Department of Internal Medicine and Cardiology, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.,Department of Cardiology, Contilia Heart and Vessel Centre, St. Marien-Hospital Mülheim, Mülheim, Germany
| | - Sebastian Kelle
- Department of Internal Medicine and Cardiology, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.,Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Burkert Pieske
- Department of Internal Medicine and Cardiology, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.,Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Alessio Alogna
- Department of Internal Medicine and Cardiology, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Carlo Campana
- Department of Cardiology Sant'Anna Hospital, ASST-Lariana, Como, Italy
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14
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B Hesselson A, Hesselson H. Hemodynamic Management of Patients with Ejection Fraction < 50% Undergoing Pulmonary Vein Ablation. J Atr Fibrillation 2021; 13:20200439. [PMID: 34950346 PMCID: PMC8691288 DOI: 10.4022/jafib.20200439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 12/31/2020] [Accepted: 01/26/2021] [Indexed: 11/10/2022]
Abstract
There is no consensus regarding optimal methodology forblood pressure monitoring inpatients with a depressed ejection fraction undergoingcatheter ablationfor atrial fibrillation. Our goalswere to determine ifhemodynamicmanagementdifferences exist during radiofrequency ablation for atrial fibrillation in patients with and without an ejection fraction< 50%, and whether management was influenced by the utilization of invasive arterial blood pressure monitoring. This single-center trial retrospectively compared blood pressure management during catheterablation of atrial fibrillationin all patients with an ejection fraction< 50% over a 2-year span (n=44), and compared to an age-matched cohort with preserved ejection fraction ablated over the same span in time (n=44). Blood pressure was not significantly managed differently between the groups, and did not appear to be influenced by the use of invasive arterial blood pressure monitoring.Hemodynamic management is similar across the spectrum of ejection fraction, regardless of invasive arterial blood pressure monitoring, which challenges the need for invasive arterial blood pressure monitoringduringcatheter ablation ofatrial fibrillationin left ventricular systolic dysfunction.
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Affiliation(s)
- Aaron B Hesselson
- University of Kentucky Division of Cardiovascular Medicine, 900 South Limestone Street, CTW 305D, Lexington, KY 40536
| | - Heather Hesselson
- University of Kentucky, College of Pharmacy, 789 S Limestone, Lexington, KY 40508
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15
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Ambrosio G, Camm AJ, Bassand JP, Corbalan R, Kayani G, Carluccio E, Mantovani LG, Virdone S, Kakkar AK. Characteristics, treatment, and outcomes of newly diagnosed atrial fibrillation patients with heart failure: GARFIELD-AF. ESC Heart Fail 2021; 8:1139-1149. [PMID: 33434417 PMCID: PMC8006724 DOI: 10.1002/ehf2.13156] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 11/04/2020] [Accepted: 11/15/2020] [Indexed: 12/13/2022] Open
Abstract
Aims Heart failure (HF) and atrial fibrillation (AF) may coexist and influence each other. However, characteristics, anticoagulant treatment, and outcomes of contemporary AF patients with concurrent HF are ill‐defined. This study analyses characteristics, treatment, and 2 year outcomes in newly diagnosed Global Anticoagulant Registry in the FIELD‐Atrial Fibrillation (GARFIELD‐AF) patients with vs. without HF. Methods and results GARFIELD‐AF is the world's largest observational AF patient study. At enrolment, 11 758 of 52 072 patients (22.6%) had HF; 76.3% were New York Heart Association class II–III. Patients with HF had comparable demographics, blood pressure, and heart rate but more likely had permanent (15.6% vs. 11.9%) or persistent AF (18.9% vs. 13.8%), acute coronary syndromes (16.7% vs. 8.9%), vascular disease (40.8% vs. 20.2%), and moderate‐to‐severe chronic kidney disease (14.6% vs. 9.0%) than those without. Anticoagulant prescription was similar between the two groups. At 2 year follow‐up, patients with HF showed a greater risk of all‐cause mortality [hazard ratio (HR), 2.06; 95% confidence interval (CI), 1.91–2.21; P < 0.0001], cardiovascular mortality (HR, 2.91; 95% CI, 2.58–3.29; P < 0.0001), acute coronary syndromes (HR, 1.25; 95% CI, 1.02–1.52; P = 0.03), and stroke/systemic embolism (HR, 1.24; 95% CI, 1.07–1.43; P = 0.0044). Major bleeding rate was comparable (adjusted HR, 1.00; 95% CI, 0.84–1.18; P = 0.968). Among patients without HF at baseline, incidence of new HF was low [0.69 (95% CI, 0.63–0.75) per 100 person‐years], whereas propensity to develop worsening HF was higher in those with HF [1.62 (95% CI, 1.45–1.80) per 100 person‐years]. Conclusions Patients with AF and HF have a high risk of all‐cause and cardiovascular mortality and stroke/systemic embolism and may develop worsening HF.
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Affiliation(s)
- Giuseppe Ambrosio
- Division of Cardiology, University of Perugia School of Medicine, Ospedale S. Maria della Misericordia, Via S. Andrea delle Fratte, Perugia, 06156, Italy
| | - A John Camm
- Cardiovascular Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St. George's, University of London and St George's University Hospitals NHS Foundation Trust, London, UK
| | - Jean-Pierre Bassand
- Thrombosis Research Institute, London, UK.,University of Besançon, Besançon, France
| | | | | | - Erberto Carluccio
- Division of Cardiology, University of Perugia School of Medicine, Ospedale S. Maria della Misericordia, Via S. Andrea delle Fratte, Perugia, 06156, Italy
| | - Lorenzo G Mantovani
- Center for Public Health Research (CESP), Postgraduate School of Hygiene and Preventive Medicine, University of Milan-Bicocca, Monza, Italy.,Value-based Healthcare Unit, IRCCS Multimedica Research Hospital, Sesto San Giovanni, Italy
| | | | - Ajay K Kakkar
- Thrombosis Research Institute, London, UK.,University College London, London, UK
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16
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Vitolo M, Proietti M, Harrison S, Lane DA, Potpara TS, Boriani G, Lip GYH. The Euro Heart Survey and EURObservational Research Programme (EORP) in atrial fibrillation registries: contribution to epidemiology, clinical management and therapy of atrial fibrillation patients over the last 20 years. Intern Emerg Med 2020; 15:1183-1192. [PMID: 32557091 DOI: 10.1007/s11739-020-02405-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 06/08/2020] [Indexed: 12/17/2022]
Abstract
Management of atrial fibrillation (AF) may be challenging in clinical practice. Given the complexity of AF patients and the continuous advances in AF clinical management, there is a need for standardized programmes aimed at collecting so-called 'real-world clinical practice data' regarding the epidemiology, diagnostic/therapeutic/management practices and assessing adherence to guidelines. Over the past 20 years, the number of registries and surveys based on real-world AF patients has been dramatically increased. In Europe, based on the Euro Heart Survey (EHS) and the EURObservational Research Programme (EORP), a large series of studies based on these prospective, observational, large-scale multicentre registries on AF have been published. This narrative review gives an overview of these two projects on AF led by the European Society of Cardiology, focusing mainly on the contribution that these studies have provided to AF management and patient outcomes. Both the EHS and the EORP registries have collected a large amount of data regarding contemporary clinical practice, and despite some limitations, mainly related to their observational nature, these registries have contributed to our knowledge and clinical management of AF patients.
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Affiliation(s)
- Marco Vitolo
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico Di Modena, Modena, Italy
| | - Marco Proietti
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Geriatric Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Stephanie Harrison
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Deirdre A Lane
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Tatjana S Potpara
- School of Medicine, University of Belgrade, Belgrade, Serbia
- Cardiology Clinic, Clinical Centre of Serbia, Belgrade, Serbia
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico Di Modena, Modena, Italy
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK.
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
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17
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Huang WY, Saver JL, Wu YL, Lin CJ, Lee M, Ovbiagele B. Major bleeding risk with non-vitamin K antagonist oral anticoagulant vs. aspirin in heart failure: network meta-analysis. ESC Heart Fail 2020; 7:3962-3970. [PMID: 32924283 PMCID: PMC7754774 DOI: 10.1002/ehf2.12994] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 06/30/2020] [Accepted: 08/17/2020] [Indexed: 11/10/2022] Open
Abstract
Aims Relative bleeding risks of different antithrombotic agents in heart failure (HF) patients is an important consideration in treatment decision making, making detailed comparative analysis desirable. The aim of this study was to conduct a network meta‐analysis to investigate the major bleeding risk for individual novel oral anticoagulants (NOACs) vs. aspirin among patients with HF. Methods and results We searched Pubmed, EMBASE, Cochrane Collaboration Central Register of Controlled Clinical Trials, and Clinicaltrials.gov from 1966 to November 2019 to identify relevant randomized clinical trials. Studies comparing individual NOACs vs. aspirin were analysed using direct study‐level meta‐analysis. Studies comparing aspirin to warfarin and NOACs to warfarin were then additionally added using network (direct and indirect) study‐level meta‐analysis. Primary endpoint was major bleeding. Final analysis included nine trials with 34 367 participants, including one direct comparison trial (apixaban vs. aspirin) and eight indirect comparison trials against the shared warfarin comparator (four aspirin trials and one trial each of apixaban, dabigatran, rivaroxaban, and edoxaban). For apixaban, network meta‐analysis combing direct and indirect comparison showed that major bleeding risk might not be different between apixaban and aspirin (odds ratio, 1.18 [95% confidence interval, 0.38 to 3.65]) in HF patients. In contrast, indirect‐comparison meta‐analysis showed dabigatran, rivaroxaban, and edoxaban compared with aspirin might be associated with a higher risk of major bleeding in HF patients. Conclusions In network meta‐analysis, apixaban might be associated with a comparable risk of major bleeding compared with aspirin in patients with HF, while other NOACs might be associated with a higher risk. However, such results were not strongly convincing because of lack of direct comparison in an original trial and small sample size of trials and participants. A clinical trial directly comparing apixaban vs. aspirin in patients with HF and sinus rhythm may be worth undertaking.
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Affiliation(s)
- Wen-Yi Huang
- Department of Neurology, College of Medicine, Chang Gung University, Chang Gung Memorial Hospital, Keelung Branch, No.222, Mai-Jin Road, Keelung, 204, Taiwan
| | - Jeffrey L Saver
- UCLA Stroke Center, University of California, 300 Medical Plaza Driveway B200, Los Angeles, CA, 90095, USA
| | - Yi-Ling Wu
- Institute of Population Health Sciences, National Health Research Institutes, No. 35, Keyan Road, Zhunan, Miaoli County, 350, Taiwan
| | - Chun-Jen Lin
- Department of Neurology, Taipei Veterans General Hospital, National Yang-Ming University, No. 201, Sec. 2, Shipai Road, Beitou District Taipei, 112, Taiwan
| | - Meng Lee
- Department of Neurology, College of Medicine, Chang Gung University, Chang Gung Memorial Hospital, Chiayi Branch, 6 West Section, Chiapu Road, Puzi, 613, Taiwan
| | - Bruce Ovbiagele
- Department of Neurology, University of California, 505 Parnassus Ave, San Francisco, CA, 94143, USA
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18
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Imamura T, Kinugawa K. Novel rate control strategy with landiolol in patients with cardiac dysfunction and atrial fibrillation. ESC Heart Fail 2020; 7:2208-2213. [PMID: 32666693 PMCID: PMC7524084 DOI: 10.1002/ehf2.12879] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 06/08/2020] [Accepted: 06/16/2020] [Indexed: 01/15/2023] Open
Abstract
While patients with acute heart failure often have tachycardia with atrial fibrillation, there have been no established medical tools that control tachycardia safely and definitely. Digoxin has been recommended as a first choice in the former guidelines, but it takes time to affect and has a risk of adverse events particularly for those with chronic kidney disease. Landiolol is a recently innovated ultra‐short‐acting beta‐blocker with 251‐fold β1/β2 selectivity, which was originally indicated only to control peri‐operative supra‐ventricular tachyarrhythmia by 2013 in Japan. We aimed to review how to use landiolol in patients with cardiac dysfunction and tachycardia due to atrial fibrillation. We reviewed recently conducted randomized control trials using landiolol, recently updated guidelines, as well as current practical use of landiolol. Japan landiolol vs. Digoxin (J‐Land) study demonstrated that landiolol was more effective to control tachycardia than digoxin in atrial fibrillation patients with left ventricular dysfunction in 2013. Given the result, the revised Japanese heart failure guideline recommends landiolol for rate control during atrial fibrillation in acute heart failure patients as Class IIa with evidence level B. Currently in Japan, landiolol is used for rate control, even in patients with advanced heart failure receiving continuous infusion of inotropes. The clinical use of landiolol in patients with cardiac dysfunction and tachycardia due to atrial fibrillation is increasing. Further studies are warranted to investigate the implication of faster and safer rate control using landiolol.
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Affiliation(s)
- Teruhiko Imamura
- Second Department of Internal Medicine, Toyama University, Toyama, Japan
| | - Koichiro Kinugawa
- Second Department of Internal Medicine, Toyama University, Toyama, Japan
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19
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Luo J, Xu S, Li H, Li Z, Liu B, Qin X, Gong M, Shi B, Wei Y. Long-term impact of new-onset atrial fibrillation complicating acute myocardial infarction on heart failure. ESC Heart Fail 2020; 7:2762-2772. [PMID: 32578394 PMCID: PMC7524129 DOI: 10.1002/ehf2.12872] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 06/01/2020] [Accepted: 06/12/2020] [Indexed: 11/21/2022] Open
Abstract
Aims New‐onset atrial fibrillation (NOAF) complicating acute myocardial infarction (AMI) has been associated with poor survival, but the clinical implication of NOAF on heart failure (HF) is still not well characterized. We aimed to investigate the relationship between NOAF complicating AMI and HF hospitalization. Methods and results Adult AMI patients identified in the New‐Onset Atrial Fibrillation Complicating Acute Myocardial Infarction in Shanghai registry who, discharged alive, had complete echocardiography and follow‐up data from February 2014 to March 2018 were included. Patients were divided according to the presence of NOAF. The outcome measures were HF hospitalization and death during the observational period (until 10 April 2019). Cox proportional hazard models were performed in the whole population and propensity score‐matched (PSM) cohort to assess the adjusted hazard ratio (HR) and 95% confidence interval (CI). Overall, 2075 patients (mean age: 65.2 ± 12.3 years, 77.3% were men) with AMI were analysed, of whom 228 (11.0%) developed NOAF. Advanced age, admission HF (Killip II–IV), impaired renal function, decreased left ventricular ejection fraction, increased heart rate, and left atrial enlargement were independent predictors of NOAF. Over a median observational period of 2.7 years, the annual incidence rates of HF hospitalization were 18.4% and 2.8% for patients with NOAF and sinus rhythm, respectively. After adjustment for confounders, NOAF was significantly associated with HF hospitalization (HR: 3.14, 95% CI: 2.30–4.28, P < 0.001). Similar results were obtained when accounting for the competing risk of all‐cause death (subdistribution HR: 3.06, 95% CI: 2.18–4.30, P < 0.001) or from the PSM cohort (HR: 2.82, 95% CI: 1.99–4.00, P < 0.001). Patients with persistent NOAF (HR: 5.81, 95% CI: 3.59–9.41) were at significantly higher risk of HF hospitalization when compared with those with transient one (HR: 2.61, 95% CI: 1.84–3.70, P interaction = 0.008). Although post‐MI NOAF was significantly related to cardiovascular death (annual incidence rates for NOAF and sinus rhythm were 9.4% and 2.3%, respectively; HR: 1.97, 95% CI: 1.36–2.85, P < 0.001), such an association was attenuated when HF hospitalization (modelled as a time‐varying covariate) and antithrombotic treatment were adjusted (HR: 1.37, 95% CI: 0.92–2.02, P = 0.121). Conclusions In patients with AMI, NOAF is strongly associated with an increased long‐term risk of HF hospitalization. Our findings suggest that strengthened secondary prevention of HF should be considered in this high‐risk population.
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Affiliation(s)
- Jiachen Luo
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Middle Yanchang Road, Jingan District, Shanghai, China
| | - Siling Xu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Middle Yanchang Road, Jingan District, Shanghai, China
| | - Hongqiang Li
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Middle Yanchang Road, Jingan District, Shanghai, China
| | - Zhiqiang Li
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Middle Yanchang Road, Jingan District, Shanghai, China
| | - Baoxin Liu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Middle Yanchang Road, Jingan District, Shanghai, China
| | - Xiaoming Qin
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Middle Yanchang Road, Jingan District, Shanghai, China
| | - Mengmeng Gong
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Middle Yanchang Road, Jingan District, Shanghai, China
| | - Beibei Shi
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Middle Yanchang Road, Jingan District, Shanghai, China
| | - Yidong Wei
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Middle Yanchang Road, Jingan District, Shanghai, China
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20
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Atrial fibrillation in chronic heart failure patients with reduced ejection fraction: The CHECK-HF registry. Int J Cardiol 2020; 308:60-66. [DOI: 10.1016/j.ijcard.2020.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 02/18/2020] [Accepted: 03/02/2020] [Indexed: 12/12/2022]
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21
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Liu J, Du X, Li M, Jia Z, Lu S, Chang S, Tang R, Bai R, Dong J, Lip GYH, Ma C. Frailty and Anticoagulant Therapy in Patients Aged 65 Years or Older with Atrial Fibrillation. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2020. [DOI: 10.15212/cvia.2019.0562] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: Elderly adults with atrial fibrillation (AF) are at increased risk of frailty and thromboembolic complications. However, studies on the prevalence of frailty in AF patients and data on the relationship between frailty and the use of anticoagulants are limited.Methods:
We conducted a cross-sectional study involving 500 participants. Patients aged 65 years or older were consecutively selected from the Chinese Atrial Fibrillation Registry study. The patient’s frailty status was assessed with use of the Canadian Study of Health and Aging Clinical Frailty
Scale. We assessed the prevalence of and factors associated with frailty, and how frailty affects anticoagulant therapy.Results: In 500 elderly adults with AF (age 75.2±6.7 years; 51.6% female), 201 patients (40.2%) were frail. The prevalence of frailty was higher in females
(P=0.002) and increased with age and CHA2DS2-VASc score (P for trend less than 0.001 for both). The factors associated with frailty were a history of heart failure (odds ratio [OR] 2.40, 95% confidence interval [CI] 1.39‐4.14), female sex (OR 2.09, 95% CI 1.27‐3.43),
and advanced age (OR 1.13, 95% CI 1.09‐1.17). Frail patients were significantly less likely to have ever been prescribed anticoagulants compared with nonfrail patients (81.7 vs. 54.9%, P<0.001).Conclusions: Frailty is prevalent in elderly adults with AF, especially in
females, those of advanced age, and those with heart failure. Frailty status has a significant impact on prescription of anticoagulants for high-risk AF patients.
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Affiliation(s)
- Jiapeng Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Xin Du
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Mengmeng Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Zhaoxu Jia
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Shangxin Lu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Sanshuai Chang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Ribo Tang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Rong Bai
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Jianzeng Dong
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Gregory Y. H. Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Changsheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China
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22
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Cremers H, Hoorn C, Theunissen L, van der Voort P, Polak P, de Jong S, van Veghel D, Dekker L. Regional collaboration to improve atrial fibrillation care: Preliminary data from the Netherlands heart network. J Arrhythm 2019; 35:604-611. [PMID: 31410231 PMCID: PMC6686280 DOI: 10.1002/joa3.12197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 04/23/2019] [Accepted: 05/04/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Guideline non-adherence and variations in therapeutic and diagnostic trajectories result in suboptimal atrial fibrillation (AF) treatments. Large academic and referral hospitals demonstrated positive effects of dedicated outpatient AF clinics. Although similar results have not been indicated in (small) non-academic hospitals yet, ample opportunities are present when collaboration is initiated on a regional level. Therefore, this study assesses the effectiveness of outpatient AF clinics in a collaborative region in the Netherlands. METHODS For this study baseline and 6 months follow-up data of a prospective cohort including newly or recently diagnosed AF-patients of 4 hospitals involved in the Netherlands Heart Network are used. From January'15 to March'16 patient relevant outcome measures (ie EHRA score, stroke, major bleedings, hospitalizations, serious adverse effects of medication, and mortality) are gathered. Descriptive and regression analyses are performed to assess the effectiveness of outpatient AF clinics. RESULTS In the analyses 448 AF-patients were included. After 6 months, significant improvements regarding EHRA score (P < 0.01), hypertension (P < 0.01), and type of AF (P < 0.01) were indicated. Results of the patient relevant outcomes showed that AF-patients were hospitalized 23 times, no major bleedings and 2 strokes occurred. Furthermore, 0 AF-patients reported serious adverse effects of medication and no AF-patients deceased. CONCLUSIONS Collaboration between cardiologists in a regional setting permits further improvement of AF care. Therefore, such quality targets are not exclusively reserved to large academic or referral hospitals. Although promising, future research should put effort in measuring the effectiveness of the outpatient AF clinics also on the long run.
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Affiliation(s)
| | | | | | | | | | | | | | - Lukas Dekker
- Catharina hospitalEindhovenThe Netherlands
- Department of Electrical EngineeringTechnical UniversityEindhovenThe Netherlands
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23
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Hyponatremia is associated with occurrence of atrial fibrillation in outpatients with heart failure and reduced ejection fraction. Hellenic J Cardiol 2019; 60:117-121. [DOI: 10.1016/j.hjc.2018.03.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 03/21/2018] [Accepted: 03/23/2018] [Indexed: 12/27/2022] Open
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24
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Matsui Y, Suzuki A, Shiga T, Arai K, Hagiwara N. Effects of Intravenous Landiolol on Heart Rate and Outcomes in Patients with Atrial Tachyarrhythmias and Acute Decompensated Heart Failure: A Single-Center Experience. Drugs Real World Outcomes 2019; 6:19-26. [PMID: 30810944 PMCID: PMC6423156 DOI: 10.1007/s40801-019-0149-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Objective Atrial tachyarrhythmias (ATAs) lead to clinical deterioration and worsening heart failure (HF) in patients with acute decompensated HF (ADHF). We evaluated the effects of the ultrashort-acting intravenous β1-blocker landiolol on the heart rate, hemodynamics, and outcome in patients with ATAs and ADHF. Methods A total of 67 consecutive hospitalized patients with ATAs and ADHF who were treated with landiolol (36 males, 67 ± 12 years) were included in this single-center retrospective study. The primary endpoints were changes in heart rate and systolic blood pressure from baseline during intravenous landiolol administration. The secondary endpoints included restoration of sinus rhythm and outcomes. Results The median maintenance dose of intravenous landiolol was 3.0 (range 1.0–12.0) μg/kg/min and the median treatment duration was 5 (range 1–24) days. Intravenous landiolol reduced heart rate (141 ± 17 beats/min at baseline to 99 ± 20 beats/min at 6 h, P < 0.001) without a marked reduction in blood pressure or deterioration of HF. During landiolol treatment, 15 (22%) patients had spontaneously restored sinus rhythm. Eight patients experienced in-hospital death, and 41 (69%) were discharged with sinus rhythm. During the follow-up of 16 ± 12 months, patients with sinus rhythm showed a lower frequency of rehospitalization due to worsening HF than patients with ATAs (5/41 vs. 7/18, P = 0.019). Conclusions Our results showed that intravenous landiolol reduces the heart rate without markedly decreasing blood pressure in patients with ATAs and ADHF. Approximately 70% of the discharged patients were in sinus rhythm, and these patients showed a lower frequency of rehospitalization due to worsening HF (UMIN-CTR no. UMIN000033650).
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Affiliation(s)
- Yuko Matsui
- Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Atsushi Suzuki
- Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Tsuyoshi Shiga
- Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
| | - Kotaro Arai
- Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Nobuhisa Hagiwara
- Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
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25
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Campodonico J, Piepoli M, Clemenza F, Bonomi A, Paolillo S, Salvioni E, Corrà U, Binno S, Veglia F, Lagioia R, Sinagra G, Cattadori G, Scardovi AB, Metra M, Senni M, Scrutinio D, Raimondo R, Emdin M, Magrì D, Parati G, Re F, Cicoira M, Minà C, Limongelli G, Correale M, Frigerio M, Bussotti M, Perna E, Battaia E, Guazzi M, Badagliacca R, Di Lenarda A, Maggioni A, Passino C, Sciomer S, Pacileo G, Mapelli M, Vignati C, Lombardi C, Filardi PP, Agostoni P. Dose-dependent efficacy of β-blocker in patients with chronic heart failure and atrial fibrillation. Int J Cardiol 2018; 273:141-146. [DOI: 10.1016/j.ijcard.2018.08.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 07/30/2018] [Accepted: 08/04/2018] [Indexed: 12/28/2022]
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26
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Balsam P, Gawałko M, Peller M, Tymińska A, Ozierański K, Zaleska M, Żukowska K, Szepietowska K, Maciejewski K, Grabowski M, Borkowski M, Kołtowski Ł, Praska-Oginska A, Zaboyska I, Opolski G, Bednarski J. Clinical characteristics and thromboembolic risk of atrial fibrillation patients with and without congestive heart failure. Results from the CRATF study. Medicine (Baltimore) 2018; 97:e13074. [PMID: 30407304 PMCID: PMC6250503 DOI: 10.1097/md.0000000000013074] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Congestive heart failure (CHF) and atrial fibrillation (AF) frequently coexist and are associated with increased risk of cardiovascular events.To compare baseline characteristics, comorbidities and pharmacotherapy in AF patients with concomitant CHF to those without CHF.The study included 3506 real-life AF patients with (37.1%) and without CHF - participants of the multicentre, retrospective MultiCenter expeRience in AFib patients Treated with OAC (CRAFT) trial (NCT02987062).All patients were treated with non-vitamin K antagonist oral anticoagulants (NOAC) or vitamin K antagonists (VKA). The frequency of NOAC among patients with and without CHF was 45.6% and 43.2%, respectively (P = .17). Patients with CHF were older (73.3 vs 64.7 years, P <.001), less likely to be women (37.4% vs 42%, P = .007), had higher CHA2DS2-VASc score (3.8 ± 1.7 vs 2.6 ± 1.8, P <.001), more often had permanent AF (53.0% vs 13.4%, P <.001), chronic obstructive pulmonary disease (16.7% vs 4.9%, P <.001), coronary artery disease (64.3% vs 29.8%, P <.001), peripheral vascular disease (65.3% vs 31.4%, P <.001), chronic kidney disease (43.1% vs 10.0%, P <.001), liver fibrosis (5.7% vs 2.6%, P <.001), neoplasm (9.6% vs 7.3%, P = .05), history of composite of stroke, transient ischemic attack or systemic embolization (16.2% vs 10.7%, P <.001), pacemaker (27.4% vs 22.1%, P = .004), implantable cardioverter-defibrillator (22.7% vs 0.8%, P <.001) or transaortic valve implantation (4.0% vs 0.8%, P <.001), cardiac resynchronization therapy (8.7% vs 0.3%, P <.001), composite of kidney transplantation, hemodialysis or creatinine level > 2.26 mg/dL (3.6% vs 0.8%, P <.001) and had less often hypertension (69.4% vs 72.5%, P = .05).Patients with AF and CHF had a higher thromboembolic risk and had more concomitant diseases.
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Affiliation(s)
- Paweł Balsam
- 1st Chair and Department of Cardiology, Medical University of Warsaw
| | - Monika Gawałko
- 1st Chair and Department of Cardiology, Medical University of Warsaw
| | - Michał Peller
- 1st Chair and Department of Cardiology, Medical University of Warsaw
| | - Agata Tymińska
- 1st Chair and Department of Cardiology, Medical University of Warsaw
| | | | - Martyna Zaleska
- 1st Chair and Department of Cardiology, Medical University of Warsaw
| | | | | | | | - Marcin Grabowski
- 1st Chair and Department of Cardiology, Medical University of Warsaw
| | | | - Łukasz Kołtowski
- 1st Chair and Department of Cardiology, Medical University of Warsaw
| | | | - Inna Zaboyska
- Cardiology Unit, John Paul II Western Hospital, Grodzisk Mazowiecki
| | - Grzegorz Opolski
- 1st Chair and Department of Cardiology, Medical University of Warsaw
| | - Janusz Bednarski
- Cardiology Unit, John Paul II Western Hospital, Grodzisk Mazowiecki
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Burashnikov A, Antzelevitch C. Is extensive atrial fibrosis in the setting of heart failure associated with a reduced atrial fibrillation burden? PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:1289-1297. [PMID: 30152017 DOI: 10.1111/pace.13474] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 08/07/2018] [Accepted: 08/16/2018] [Indexed: 01/30/2023]
Abstract
Atrial fibrillation (AF) affects 10-50% of patients with chronic heart failure (HF) and is associated with poor long-term prognosis. AF is commonly associated with atrial structural remodeling (ASR), principally characterized by atrial dilatation and fibrosis. However, the occurrence of AF in the full spectrum of ASR encountered in patients with HF is poorly defined. Experimental studies have presented evidence that extensive ASR can be accompanied with a reduced burden of AF, secondary to a prominent depression of atrial excitability. This reduction in AF burden is associated with severe atrial fibrosis rather than with dilatation. Clinical studies of patients with HF point to the possibility that advanced ASR is associated with a less frequent AF occurrence than moderate ASR. Our goal in this review is to introduce the hypothesis that AF is less likely to occur in severe versus moderate atrial ASR in the setting of HF and that it is severe atrial fibrosis-associated depression of atrial excitability that reduces AF burden.
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Affiliation(s)
- Alexander Burashnikov
- Lankenau Institute for Medical Research, Wynnewood, PA, USA.,Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Charles Antzelevitch
- Lankenau Institute for Medical Research, Wynnewood, PA, USA.,Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA.,Lankenau Heart Institute, Main Line Health, Wynnewood, PA, USA
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28
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Sustained atrial fibrillation increases the risk of anticoagulation-related bleeding in heart failure. Clin Res Cardiol 2018; 107:1170-1179. [PMID: 29948286 DOI: 10.1007/s00392-018-1293-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 06/05/2018] [Indexed: 10/14/2022]
Abstract
BACKGROUND Oral anticoagulation therapy in individuals with atrial fibrillation (AF) reduces the risk of thromboembolic events at cost of an increased bleeding risk. Whether anticoagulation-related outcomes differ between patients with paroxysmal and sustained AF receiving anticoagulation is controversially discussed. METHODS In the present analysis of the prospective multi-center cohort study thrombEVAL, the incidence of anticoagulation-related adverse events was analyzed according to the AF phenotype. Information on outcome was centrally recorded over 3 years, validated via medical records and adjudicated by an independent review panel. Study monitoring was provided by an independent institution. RESULTS Overall, the sample comprised 1089 AF individuals, of whom n = 398 had paroxysmal AF and n = 691 experienced sustained AF. In Cox regression analysis with adjustment for potential confounders, sustained AF indicated an independently elevated risk of clinically relevant bleeding compared to paroxysmal AF [hazard ratio (HR) 1.40 (1.02; 1.93); P = 0.038]. For clinically relevant bleeding, a significant interaction of the pattern of AF type with concomitant heart failure (HF) was detected: HRHF 2.45 (1.51, 3.98) vs. HRno HF 0.85 (0.55, 1.34); Pinteraction = 0.003. In HF patients, sustained AF indicated also an elevated risk of major bleeding [HR 2.25 (1.26, 4.20); P = 0.006]. A simplified HAS-BLED score incorporating only information on age (> 65 years), bleeding history, and HF with sustained AF demonstrated better discriminative performance for clinically relevant bleeding than the original version: AUCHAS-BLED: 0.583 vs. AUCsimplifiedHAS-BLED: 0.642 (P = 0.004). CONCLUSIONS In HF patients receiving oral anticoagulation, sustained AF indicates a substantially elevated risk of bleeding. CLINICAL TRIAL REGISTRATION https://clinicaltrials.gov , identifier: NCT01809015.
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Oliva F, Sormani P, Contri R, Campana C, Carubelli V, Cirò A, Morandi F, Di Tano G, Mortara A, Senni M, Metra M, Ammirati E. Heart rate as a prognostic marker and therapeutic target in acute and chronic heart failure. Int J Cardiol 2018; 253:97-104. [DOI: 10.1016/j.ijcard.2017.09.191] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 06/12/2017] [Accepted: 09/22/2017] [Indexed: 12/28/2022]
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30
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Marrouche NF, Brachmann J, Andresen D, Siebels J, Boersma L, Jordaens L, Merkely B, Pokushalov E, Sanders P, Proff J, Schunkert H, Christ H, Vogt J, Bänsch D. Catheter Ablation for Atrial Fibrillation with Heart Failure. N Engl J Med 2018; 378:417-427. [PMID: 29385358 DOI: 10.1056/nejmoa1707855] [Citation(s) in RCA: 1385] [Impact Index Per Article: 230.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Mortality and morbidity are higher among patients with atrial fibrillation and heart failure than among those with heart failure alone. Catheter ablation for atrial fibrillation has been proposed as a means of improving outcomes among patients with heart failure who are otherwise receiving appropriate treatment. METHODS We randomly assigned patients with symptomatic paroxysmal or persistent atrial fibrillation who did not have a response to antiarrhythmic drugs, had unacceptable side effects, or were unwilling to take these drugs to undergo either catheter ablation (179 patients) or medical therapy (rate or rhythm control) (184 patients) for atrial fibrillation in addition to guidelines-based therapy for heart failure. All the patients had New York Heart Association class II, III, or IV heart failure, a left ventricular ejection fraction of 35% or less, and an implanted defibrillator. The primary end point was a composite of death from any cause or hospitalization for worsening heart failure. RESULTS After a median follow-up of 37.8 months, the primary composite end point occurred in significantly fewer patients in the ablation group than in the medical-therapy group (51 patients [28.5%] vs. 82 patients [44.6%]; hazard ratio, 0.62; 95% confidence interval [CI], 0.43 to 0.87; P=0.007). Significantly fewer patients in the ablation group died from any cause (24 [13.4%] vs. 46 [25.0%]; hazard ratio, 0.53; 95% CI, 0.32 to 0.86; P=0.01), were hospitalized for worsening heart failure (37 [20.7%] vs. 66 [35.9%]; hazard ratio, 0.56; 95% CI, 0.37 to 0.83; P=0.004), or died from cardiovascular causes (20 [11.2%] vs. 41 [22.3%]; hazard ratio, 0.49; 95% CI, 0.29 to 0.84; P=0.009). CONCLUSIONS Catheter ablation for atrial fibrillation in patients with heart failure was associated with a significantly lower rate of a composite end point of death from any cause or hospitalization for worsening heart failure than was medical therapy. (Funded by Biotronik; CASTLE-AF ClinicalTrials.gov number, NCT00643188 .).
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Affiliation(s)
- Nassir F Marrouche
- From the Comprehensive Arrhythmia Research and Management Center, Division of Cardiovascular Medicine, School of Medicine, University of Utah Health, Salt Lake City (N.F.M.); Klinikum Coburg, Coburg (J.B.), Kardiologie an den Ev. Elisabeth-Kliniken (D.A.) and Biotronik (J.P., H.S.), Berlin, Klinik Rotes Kreuz, Frankfurt/Main (J.S.), Klinikum Links der Weser, Bremen (L.B.), Deutsches Herzzentrum München, Munich (H.C.), Institute of Medical Statistics and Computational Biology, Cologne (D.B.), and KMG Klinikum, Güstrow (J.V.) - all in Germany; Antonius Ziekenhuis Nieuwegein, Nieuwegein (L.J.), and the Erasmus University Medical Center, Rotterdam (B.M.) - both in the Netherlands; Semmelweis Medical University, Budapest, Hungary (E.P.); and the State Research Institute of Circulation Pathology, Novosibirsk, Russia (P.S.)
| | - Johannes Brachmann
- From the Comprehensive Arrhythmia Research and Management Center, Division of Cardiovascular Medicine, School of Medicine, University of Utah Health, Salt Lake City (N.F.M.); Klinikum Coburg, Coburg (J.B.), Kardiologie an den Ev. Elisabeth-Kliniken (D.A.) and Biotronik (J.P., H.S.), Berlin, Klinik Rotes Kreuz, Frankfurt/Main (J.S.), Klinikum Links der Weser, Bremen (L.B.), Deutsches Herzzentrum München, Munich (H.C.), Institute of Medical Statistics and Computational Biology, Cologne (D.B.), and KMG Klinikum, Güstrow (J.V.) - all in Germany; Antonius Ziekenhuis Nieuwegein, Nieuwegein (L.J.), and the Erasmus University Medical Center, Rotterdam (B.M.) - both in the Netherlands; Semmelweis Medical University, Budapest, Hungary (E.P.); and the State Research Institute of Circulation Pathology, Novosibirsk, Russia (P.S.)
| | - Dietrich Andresen
- From the Comprehensive Arrhythmia Research and Management Center, Division of Cardiovascular Medicine, School of Medicine, University of Utah Health, Salt Lake City (N.F.M.); Klinikum Coburg, Coburg (J.B.), Kardiologie an den Ev. Elisabeth-Kliniken (D.A.) and Biotronik (J.P., H.S.), Berlin, Klinik Rotes Kreuz, Frankfurt/Main (J.S.), Klinikum Links der Weser, Bremen (L.B.), Deutsches Herzzentrum München, Munich (H.C.), Institute of Medical Statistics and Computational Biology, Cologne (D.B.), and KMG Klinikum, Güstrow (J.V.) - all in Germany; Antonius Ziekenhuis Nieuwegein, Nieuwegein (L.J.), and the Erasmus University Medical Center, Rotterdam (B.M.) - both in the Netherlands; Semmelweis Medical University, Budapest, Hungary (E.P.); and the State Research Institute of Circulation Pathology, Novosibirsk, Russia (P.S.)
| | - Jürgen Siebels
- From the Comprehensive Arrhythmia Research and Management Center, Division of Cardiovascular Medicine, School of Medicine, University of Utah Health, Salt Lake City (N.F.M.); Klinikum Coburg, Coburg (J.B.), Kardiologie an den Ev. Elisabeth-Kliniken (D.A.) and Biotronik (J.P., H.S.), Berlin, Klinik Rotes Kreuz, Frankfurt/Main (J.S.), Klinikum Links der Weser, Bremen (L.B.), Deutsches Herzzentrum München, Munich (H.C.), Institute of Medical Statistics and Computational Biology, Cologne (D.B.), and KMG Klinikum, Güstrow (J.V.) - all in Germany; Antonius Ziekenhuis Nieuwegein, Nieuwegein (L.J.), and the Erasmus University Medical Center, Rotterdam (B.M.) - both in the Netherlands; Semmelweis Medical University, Budapest, Hungary (E.P.); and the State Research Institute of Circulation Pathology, Novosibirsk, Russia (P.S.)
| | - Lucas Boersma
- From the Comprehensive Arrhythmia Research and Management Center, Division of Cardiovascular Medicine, School of Medicine, University of Utah Health, Salt Lake City (N.F.M.); Klinikum Coburg, Coburg (J.B.), Kardiologie an den Ev. Elisabeth-Kliniken (D.A.) and Biotronik (J.P., H.S.), Berlin, Klinik Rotes Kreuz, Frankfurt/Main (J.S.), Klinikum Links der Weser, Bremen (L.B.), Deutsches Herzzentrum München, Munich (H.C.), Institute of Medical Statistics and Computational Biology, Cologne (D.B.), and KMG Klinikum, Güstrow (J.V.) - all in Germany; Antonius Ziekenhuis Nieuwegein, Nieuwegein (L.J.), and the Erasmus University Medical Center, Rotterdam (B.M.) - both in the Netherlands; Semmelweis Medical University, Budapest, Hungary (E.P.); and the State Research Institute of Circulation Pathology, Novosibirsk, Russia (P.S.)
| | - Luc Jordaens
- From the Comprehensive Arrhythmia Research and Management Center, Division of Cardiovascular Medicine, School of Medicine, University of Utah Health, Salt Lake City (N.F.M.); Klinikum Coburg, Coburg (J.B.), Kardiologie an den Ev. Elisabeth-Kliniken (D.A.) and Biotronik (J.P., H.S.), Berlin, Klinik Rotes Kreuz, Frankfurt/Main (J.S.), Klinikum Links der Weser, Bremen (L.B.), Deutsches Herzzentrum München, Munich (H.C.), Institute of Medical Statistics and Computational Biology, Cologne (D.B.), and KMG Klinikum, Güstrow (J.V.) - all in Germany; Antonius Ziekenhuis Nieuwegein, Nieuwegein (L.J.), and the Erasmus University Medical Center, Rotterdam (B.M.) - both in the Netherlands; Semmelweis Medical University, Budapest, Hungary (E.P.); and the State Research Institute of Circulation Pathology, Novosibirsk, Russia (P.S.)
| | - Béla Merkely
- From the Comprehensive Arrhythmia Research and Management Center, Division of Cardiovascular Medicine, School of Medicine, University of Utah Health, Salt Lake City (N.F.M.); Klinikum Coburg, Coburg (J.B.), Kardiologie an den Ev. Elisabeth-Kliniken (D.A.) and Biotronik (J.P., H.S.), Berlin, Klinik Rotes Kreuz, Frankfurt/Main (J.S.), Klinikum Links der Weser, Bremen (L.B.), Deutsches Herzzentrum München, Munich (H.C.), Institute of Medical Statistics and Computational Biology, Cologne (D.B.), and KMG Klinikum, Güstrow (J.V.) - all in Germany; Antonius Ziekenhuis Nieuwegein, Nieuwegein (L.J.), and the Erasmus University Medical Center, Rotterdam (B.M.) - both in the Netherlands; Semmelweis Medical University, Budapest, Hungary (E.P.); and the State Research Institute of Circulation Pathology, Novosibirsk, Russia (P.S.)
| | - Evgeny Pokushalov
- From the Comprehensive Arrhythmia Research and Management Center, Division of Cardiovascular Medicine, School of Medicine, University of Utah Health, Salt Lake City (N.F.M.); Klinikum Coburg, Coburg (J.B.), Kardiologie an den Ev. Elisabeth-Kliniken (D.A.) and Biotronik (J.P., H.S.), Berlin, Klinik Rotes Kreuz, Frankfurt/Main (J.S.), Klinikum Links der Weser, Bremen (L.B.), Deutsches Herzzentrum München, Munich (H.C.), Institute of Medical Statistics and Computational Biology, Cologne (D.B.), and KMG Klinikum, Güstrow (J.V.) - all in Germany; Antonius Ziekenhuis Nieuwegein, Nieuwegein (L.J.), and the Erasmus University Medical Center, Rotterdam (B.M.) - both in the Netherlands; Semmelweis Medical University, Budapest, Hungary (E.P.); and the State Research Institute of Circulation Pathology, Novosibirsk, Russia (P.S.)
| | - Prashanthan Sanders
- From the Comprehensive Arrhythmia Research and Management Center, Division of Cardiovascular Medicine, School of Medicine, University of Utah Health, Salt Lake City (N.F.M.); Klinikum Coburg, Coburg (J.B.), Kardiologie an den Ev. Elisabeth-Kliniken (D.A.) and Biotronik (J.P., H.S.), Berlin, Klinik Rotes Kreuz, Frankfurt/Main (J.S.), Klinikum Links der Weser, Bremen (L.B.), Deutsches Herzzentrum München, Munich (H.C.), Institute of Medical Statistics and Computational Biology, Cologne (D.B.), and KMG Klinikum, Güstrow (J.V.) - all in Germany; Antonius Ziekenhuis Nieuwegein, Nieuwegein (L.J.), and the Erasmus University Medical Center, Rotterdam (B.M.) - both in the Netherlands; Semmelweis Medical University, Budapest, Hungary (E.P.); and the State Research Institute of Circulation Pathology, Novosibirsk, Russia (P.S.)
| | - Jochen Proff
- From the Comprehensive Arrhythmia Research and Management Center, Division of Cardiovascular Medicine, School of Medicine, University of Utah Health, Salt Lake City (N.F.M.); Klinikum Coburg, Coburg (J.B.), Kardiologie an den Ev. Elisabeth-Kliniken (D.A.) and Biotronik (J.P., H.S.), Berlin, Klinik Rotes Kreuz, Frankfurt/Main (J.S.), Klinikum Links der Weser, Bremen (L.B.), Deutsches Herzzentrum München, Munich (H.C.), Institute of Medical Statistics and Computational Biology, Cologne (D.B.), and KMG Klinikum, Güstrow (J.V.) - all in Germany; Antonius Ziekenhuis Nieuwegein, Nieuwegein (L.J.), and the Erasmus University Medical Center, Rotterdam (B.M.) - both in the Netherlands; Semmelweis Medical University, Budapest, Hungary (E.P.); and the State Research Institute of Circulation Pathology, Novosibirsk, Russia (P.S.)
| | - Heribert Schunkert
- From the Comprehensive Arrhythmia Research and Management Center, Division of Cardiovascular Medicine, School of Medicine, University of Utah Health, Salt Lake City (N.F.M.); Klinikum Coburg, Coburg (J.B.), Kardiologie an den Ev. Elisabeth-Kliniken (D.A.) and Biotronik (J.P., H.S.), Berlin, Klinik Rotes Kreuz, Frankfurt/Main (J.S.), Klinikum Links der Weser, Bremen (L.B.), Deutsches Herzzentrum München, Munich (H.C.), Institute of Medical Statistics and Computational Biology, Cologne (D.B.), and KMG Klinikum, Güstrow (J.V.) - all in Germany; Antonius Ziekenhuis Nieuwegein, Nieuwegein (L.J.), and the Erasmus University Medical Center, Rotterdam (B.M.) - both in the Netherlands; Semmelweis Medical University, Budapest, Hungary (E.P.); and the State Research Institute of Circulation Pathology, Novosibirsk, Russia (P.S.)
| | - Hildegard Christ
- From the Comprehensive Arrhythmia Research and Management Center, Division of Cardiovascular Medicine, School of Medicine, University of Utah Health, Salt Lake City (N.F.M.); Klinikum Coburg, Coburg (J.B.), Kardiologie an den Ev. Elisabeth-Kliniken (D.A.) and Biotronik (J.P., H.S.), Berlin, Klinik Rotes Kreuz, Frankfurt/Main (J.S.), Klinikum Links der Weser, Bremen (L.B.), Deutsches Herzzentrum München, Munich (H.C.), Institute of Medical Statistics and Computational Biology, Cologne (D.B.), and KMG Klinikum, Güstrow (J.V.) - all in Germany; Antonius Ziekenhuis Nieuwegein, Nieuwegein (L.J.), and the Erasmus University Medical Center, Rotterdam (B.M.) - both in the Netherlands; Semmelweis Medical University, Budapest, Hungary (E.P.); and the State Research Institute of Circulation Pathology, Novosibirsk, Russia (P.S.)
| | - Jürgen Vogt
- From the Comprehensive Arrhythmia Research and Management Center, Division of Cardiovascular Medicine, School of Medicine, University of Utah Health, Salt Lake City (N.F.M.); Klinikum Coburg, Coburg (J.B.), Kardiologie an den Ev. Elisabeth-Kliniken (D.A.) and Biotronik (J.P., H.S.), Berlin, Klinik Rotes Kreuz, Frankfurt/Main (J.S.), Klinikum Links der Weser, Bremen (L.B.), Deutsches Herzzentrum München, Munich (H.C.), Institute of Medical Statistics and Computational Biology, Cologne (D.B.), and KMG Klinikum, Güstrow (J.V.) - all in Germany; Antonius Ziekenhuis Nieuwegein, Nieuwegein (L.J.), and the Erasmus University Medical Center, Rotterdam (B.M.) - both in the Netherlands; Semmelweis Medical University, Budapest, Hungary (E.P.); and the State Research Institute of Circulation Pathology, Novosibirsk, Russia (P.S.)
| | - Dietmar Bänsch
- From the Comprehensive Arrhythmia Research and Management Center, Division of Cardiovascular Medicine, School of Medicine, University of Utah Health, Salt Lake City (N.F.M.); Klinikum Coburg, Coburg (J.B.), Kardiologie an den Ev. Elisabeth-Kliniken (D.A.) and Biotronik (J.P., H.S.), Berlin, Klinik Rotes Kreuz, Frankfurt/Main (J.S.), Klinikum Links der Weser, Bremen (L.B.), Deutsches Herzzentrum München, Munich (H.C.), Institute of Medical Statistics and Computational Biology, Cologne (D.B.), and KMG Klinikum, Güstrow (J.V.) - all in Germany; Antonius Ziekenhuis Nieuwegein, Nieuwegein (L.J.), and the Erasmus University Medical Center, Rotterdam (B.M.) - both in the Netherlands; Semmelweis Medical University, Budapest, Hungary (E.P.); and the State Research Institute of Circulation Pathology, Novosibirsk, Russia (P.S.)
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Yamada S, Fong MC, Hsiao YW, Chang SL, Tsai YN, Lo LW, Chao TF, Lin YJ, Hu YF, Chung FP, Liao JN, Chang YT, Li HY, Higa S, Chen SA. Impact of Renal Denervation on Atrial Arrhythmogenic Substrate in Ischemic Model of Heart Failure. J Am Heart Assoc 2018; 7:JAHA.117.007312. [PMID: 29358197 PMCID: PMC5850156 DOI: 10.1161/jaha.117.007312] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Myocardial infarction increases the risk of heart failure (HF) and atrial fibrillation. Renal denervation (RDN) might suppress the development of atrial remodeling. This study aimed to elucidate the molecular mechanism of RDN in the suppression of atrial fibrillation in a HF model after myocardial infarction. METHODS AND RESULTS HF rabbits were created 4 weeks after coronary ligation. Rabbits were classified into 3 groups: normal control (n=10), HF (n=10), and HF-RDN (n=6). Surgical and chemical RDN were approached through midabdominal incisions in HF-RDN. Left anterior descending coronary artery in HF and HF-RDN was ligated to create myocardial infarction. After electrophysiological study, the rabbits were euthanized and the left atrial appendage was harvested for real-time polymerase chain reaction analysis and Trichrome stain. Left atrial dimension and left ventricular mass were smaller in HF-RDN by echocardiography compared with HF. Attenuated atrial fibrosis and tyrosine hydroxylase levels were observed in HF-RDN compared with HF. The mRNA expressions of Cav1.2, Nav1.5, Kir2.1, KvLQT1, phosphoinositide 3-kinase, AKT, and endothelial nitric oxide synthase in HF-RDN were significantly higher compared with HF. The effective refractory period and action potential duration of HF-RDN were significantly shorter compared with HF. Decreased atrial fibrillation inducibility was noted in HF-RDN compared with HF (50% versus 100%, P<0.05). CONCLUSIONS RDN reversed atrial electrical and structural remodeling, and suppressed the atrial fibrillation inducibility in an ischemic HF model. The beneficial effect of RDN may be related to prevention of the downregulation of the phosphoinositide 3-kinase/AKT/endothelial nitric oxide synthase signaling pathway.
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Affiliation(s)
- Shinya Yamada
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Man-Cai Fong
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan.,Division of Cardiology, Department of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Ya-Wen Hsiao
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shih-Lin Chang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan .,Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Yung-Nan Tsai
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Li-Wei Lo
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Tze-Fan Chao
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Yenn-Jiang Lin
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Yu-Feng Hu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Fa-Po Chung
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Jo-Nan Liao
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Yao-Ting Chang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Hsing-Yuan Li
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Satoshi Higa
- Division of Cardiovascular Medicine, Cardiac Electrophysiology and Pacing Laboratory, Makiminato Central Hospital, Okinawa, Japan
| | - Shih-Ann Chen
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
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32
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von Haehling S, Bělohlávek J, Er F, Gassanov N, Guarracino F, Bouvet O. Landiolol for rate control management of atrial fibrillation in patients with cardiac dysfunction. Eur Heart J Suppl 2018; 20:A19-A24. [PMID: 30188957 PMCID: PMC5909772 DOI: 10.1093/eurheartj/sux035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Atrial fibrillation (AFib) is frequently associated with heart failure. Guidelines for AFib management have been recently updated and include an algorithm for acute heart rate control based on left ventricular ejection fraction and haemodynamics. Landiolol is an injectable ultra-short beta-blocker with very high beta-1 selectivity, listed in Japanese Guidelines for AFib management as potential option for rate control of patient with heart failure. Landiolol is now available in Europe with indication of controlling heart rate in AFib and supraventricular tachycardia. This review discusses existing clinical data in Japan and perspectives of landiolol use for acute rate control of AFib patients with cardiac dysfunction.
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Affiliation(s)
- Stephan von Haehling
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Robert-Koch-Strasse 40, Göttingen, Germany
| | - Jan Bělohlávek
- Department of Internal Medicine, Cardiovascular Medicine, General Teaching Hospital and 1st Faculty of Medicine, Charles University, U Nemocnice 2, Praha 2, Prague, Czech Republic
| | - Fikret Er
- Department of Cardiology, Rhythmology and Intensive Care Medicine, Klinikum Gütersloh, Germany
| | - Natig Gassanov
- Department of Cardiology, Rhythmology and Intensive Care Medicine, Klinikum Gütersloh, Germany
| | - Fabio Guarracino
- Department of Anaesthesia and Critical Care Medicine, Cardiothoracic and Vascular Anaesthesia, Azienda Ospedaliero Universitaria Pisana, Via Roma n. 67, Pisa, Italy
| | - Olivier Bouvet
- Department of Clinical Research and Pharmaceutical Development, Amomed Pharma GmbH Vienna, Austria
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33
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Yamada S, Lo LW, Chen SA. Reply to letter to the editor: "A potential and lionhearted soldier for atrial fibrillation accompanied with heart failure: Renal denervation". Int J Cardiol 2017; 243:282. [PMID: 28747033 DOI: 10.1016/j.ijcard.2017.05.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 05/08/2017] [Indexed: 11/24/2022]
Affiliation(s)
- Shinya Yamada
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taiwan; Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Li-Wei Lo
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taiwan; Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Shih-Ann Chen
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taiwan; Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan.
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34
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Yamada S, Lo LW, Chou YH, Lin WL, Chang SL, Lin YJ, Chen SA. Renal denervation regulates the atrial arrhythmogenic substrates through reverse structural remodeling in heart failure rabbit model. Int J Cardiol 2017; 235:105-113. [DOI: 10.1016/j.ijcard.2017.02.085] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 01/04/2017] [Accepted: 02/20/2017] [Indexed: 12/13/2022]
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35
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Díaz-Martínez JC, Duque-Ramírez M, Marín-Velásquez JE, Aristizábal-Aristizábal JM, Velásquez-Vélez JE, Uribe-Arango W. Costos asociados a la fibrilación auricular. REVISTA COLOMBIANA DE CARDIOLOGÍA 2016. [DOI: 10.1016/j.rccar.2016.10.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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36
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Fauchier L, Villejoubert O, Clementy N, Bernard A, Pierre B, Angoulvant D, Ivanes F, Babuty D, Lip GYH. Causes of Death and Influencing Factors in Patients with Atrial Fibrillation. Am J Med 2016; 129:1278-1287. [PMID: 27476087 DOI: 10.1016/j.amjmed.2016.06.045] [Citation(s) in RCA: 120] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 06/22/2016] [Accepted: 06/24/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Atrial fibrillation is associated with a higher mortality, but causes of death of atrial fibrillation patients and their specific predictors have been less well defined. We aimed to identify the causes of death among atrial fibrillation patients and secondly, clinical predictors for the different modes of deaths. METHODS Patients diagnosed with atrial fibrillation in a four-hospital institution between 2000 and 2010 were identified. During a follow-up of 929 ± 1082 days (median 456, interquartile 10-1584), 1253 deaths were recorded (yearly rate 5.5%). RESULTS Cardiovascular deaths accounted for 54% and noncardiovascular for 43%. The three main causes of death were heart failure (29%), infection (18%), and cancer (12%). Fatal stroke or fatal bleeding each accounted for 7% of all deaths. On multivariate analysis, the strongest predictors of death were permanent atrial fibrillation, heart failure (whether with decreased or with preserved ejection fraction), previous bleeding, and renal failure, which were independently associated with an increase in the risk of all-cause mortality (35%, 78%, 42%, and 79%, respectively), cardiovascular mortality (43%, 129%, 46%, and 93%, respectively), and noncardiovascular mortality (21%, 45%, 40%, and 50%, respectively). Oral anticoagulant use was independently associated with a lower risk of all-cause mortality (hazard ratio [HR] 0.62; 95% confidence interval [CI], 0.54-0.71; P <.0001), cardiovascular mortality (HR 0.60; 95% CI, 0.49-0.72; P <.0001), and noncardiovascular mortality (HR 0.60; 95% CI, 0.49-0.74; P <.0001). CONCLUSIONS The majority of deaths were related to a cardiovascular origin, and heart failure was the most common cause of death in atrial fibrillation patients. Despite the high risk of stroke associated with atrial fibrillation, only 7% died from stroke. Optimization of management of any underlying heart disease and associated comorbidities should be a relevant therapeutic target to reduce total mortality in atrial fibrillation patients.
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Affiliation(s)
- Laurent Fauchier
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université François Rabelais, Tours, France.
| | - Olivier Villejoubert
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université François Rabelais, Tours, France
| | - Nicolas Clementy
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université François Rabelais, Tours, France
| | - Anne Bernard
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université François Rabelais, Tours, France
| | - Bertrand Pierre
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université François Rabelais, Tours, France
| | - Denis Angoulvant
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université François Rabelais, Tours, France
| | - Fabrice Ivanes
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université François Rabelais, Tours, France
| | - Dominique Babuty
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université François Rabelais, Tours, France
| | - Gregory Y H Lip
- University of Birmingham Institute of Cardiovascular Sciences, City Hospital, UK; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Denmark
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37
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Gigli L, Ameri P, Secco G, De Blasi G, Miceli R, Lorenzoni A, Torre F, Chiarella F, Brunelli C, Canepa M. Clinical characteristics and prognostic impact of atrial fibrillation in patients with chronic heart failure. World J Cardiol 2016; 8:647-656. [PMID: 27957251 PMCID: PMC5124723 DOI: 10.4330/wjc.v8.i11.647] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 08/25/2016] [Accepted: 09/08/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To assess the prevalence, clinical characteristics and independent prognostic impact of atrial fibrillation (AF) in chronic heart failure (CHF) patients, and the potential protective effect of disease-modifying medications, particularly beta-blockers (BB).
METHODS We retrospectively reviewed the charts of patients referred to our center since January 2004, and collected all clinical information available at their first visit. We assessed mortality to the end of June 2015. We compared patients with and without AF, and assessed the association between AF and all-cause mortality by multivariate Cox regression and Kaplan-Meyer analysis, particularly accounting for ongoing treatment with BB.
RESULTS A total of 903 patients were evaluated (mean age 68 ± 12 years, 73% male). Prevalence of AF was 19%, ranging from 10% to 28% in patients ≤ 60 and ≥ 77 years, respectively. Besides the older age, patients with AF had more symptoms (New York Heart Association II-III 60% vs 44%), lower prevalence of dyslipidemia (23% vs 37%), coronary artery disease (28% vs 52%) and left bundle branch block (9% vs 16%). On the contrary, they more frequently presented with an idiopathic etiology (50% vs 24%), a history of valve surgery (13% vs 4%) and received overall more devices implantation (31% vs 21%). The use of disease-modifying medications (i.e., BB and ACE inhibitors/angiotensin receptor blockers) was lower in patients with AF (72% vs 80% and 71% vs 79%, respectively), who on the contrary were more frequently treated with symptomatic and antiarrhythmic drugs including diuretics (87% vs 69%) and digoxin (51% vs 11%). At a mean follow-up of about 5 years, all-cause mortality was significantly higher in patients with AF as compared to those in sinus rhythm (SR) (45% vs 34%, P value < 0.05 for all previous comparisons). However, in a multivariate analysis including the main significant predictors of all-cause mortality, the univariate relationship between AF and death (HR = 1.49, 95%CI: 1.15-1.92) became not statistically significant (HR = 0.98, 95%CI: 0.73-1.32). Nonetheless, patients with AF not receiving BB treatment were found to have the worst prognosis, followed by patients with SR not receiving BB therapy and patients with AF receiving BB therapy, who both had similarly worse survival when compared to patients with SR receiving BB therapy.
CONCLUSION AF was highly prevalent and associated with older age, worse clinical presentation and underutilization of disease-modifying medications such as BB in a population of elderly patients with CHF. AF had no independent impact on mortality, but the underutilization of BB in this group of patients was associated to a worse long-term prognosis.
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38
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Hawkins NM, Jhund PS, Pozzi A, O'Meara E, Solomon SD, Granger CB, Yusuf S, Pfeffer MA, Swedberg K, Petrie MC, Virani S, McMurray JJ. Severity of renal impairment in patients with heart failure and atrial fibrillation: implications for non-vitamin K antagonist oral anticoagulant dose adjustment. Eur J Heart Fail 2016; 18:1162-71. [DOI: 10.1002/ejhf.614] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Revised: 05/13/2016] [Accepted: 06/04/2016] [Indexed: 11/06/2022] Open
Affiliation(s)
| | - Pardeep S. Jhund
- BHF Glasgow Cardiovascular Research Centre; University of Glasgow; Glasgow UK
| | - Andrea Pozzi
- BHF Glasgow Cardiovascular Research Centre; University of Glasgow; Glasgow UK
| | | | - Scott D. Solomon
- Division of Cardiovascular Medicine; Brigham and Women's Hospital; Boston MA USA
| | | | - Salim Yusuf
- Population Health Research Institute; McMaster University; Hamilton Canada
| | - Marc A. Pfeffer
- Division of Cardiovascular Medicine; Brigham and Women's Hospital; Boston MA USA
| | | | - Mark C. Petrie
- Scottish National Advanced Heart Failure Service; Golden Jubilee National Hospital; Clydebank Glasgow UK
| | - Sean Virani
- Division of Cardiology; University of British Columbia; Vancouver Canada
| | - John J.V. McMurray
- BHF Glasgow Cardiovascular Research Centre; University of Glasgow; Glasgow UK
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Garcia B, Clementy N, Benhenda N, Pierre B, Babuty D, Olshansky B, Fauchier L. Mortality After Atrioventricular Nodal Radiofrequency Catheter Ablation With Permanent Ventricular Pacing in Atrial Fibrillation. Circ Arrhythm Electrophysiol 2016; 9:CIRCEP.116.003993. [DOI: 10.1161/circep.116.003993] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 05/27/2016] [Indexed: 11/16/2022]
Abstract
Background—
Atrioventricular nodal radiofrequency ablation (AVNA) with permanent ventricular pacing can be used to control rate in patients with atrial fibrillation (AF). However, long-term outcomes after AVNA are uncertain, especially in light of irreversible pacemaker dependence.
Methods and Results—
We examined 9122 consecutive patients with AF. The outcomes in 453 patients with AVNA (26% of whom underwent an implantable cardiac defibrillator implant and 37% underwent cardiac resynchronization therapy implant) were compared with AF patients without AVNA after propensity score 1:1 matching. During follow-up in the propensity-matched cohort (2.41±3.23 years, median 1.23, quartiles 0.33–3.12), 100 patients died (yearly rate of death 6.6%). Mode of death was available in 86% of patients, which was cardiovascular in 67% of the patients (related to heart failure in 38%, sudden death in 5%, and other cardiovascular reason in 24%) and noncardiovascular in 33%. AVNA in patients with AF was associated with a lower risk of mortality (odds ratio 0.47, 95% confidence interval, 0.29–0.77;
P
=0.003), a lower risk of cardiovascular mortality (odds ratio =0.41, 95% confidence interval 0.23–0.73;
P
=0.003), and nonsignificant lower risk of stroke and thromboembolic events (odds ratio =0.61, 95% confidence interval 0.36–1.06;
P
=0.08).
Conclusions—
In sick AF patients with multiple comorbidities, AVNA with permanent ventricular pacing for rate control seems safe during follow-up and may be associated with lower mortality.
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Affiliation(s)
- Bruno Garcia
- From the Service de Cardiologie, Pôle Cœur Thorax Vasculaire, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université François Rabelais, Tours, France (B.G., N.C., N.B., B.P., D.B., L.F.); and Division of Cardiology, Cardiac Electrophysiology, Mercy Hospital-North Iowa, Mason City, IA (B.O.)
| | - Nicolas Clementy
- From the Service de Cardiologie, Pôle Cœur Thorax Vasculaire, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université François Rabelais, Tours, France (B.G., N.C., N.B., B.P., D.B., L.F.); and Division of Cardiology, Cardiac Electrophysiology, Mercy Hospital-North Iowa, Mason City, IA (B.O.)
| | - Nazih Benhenda
- From the Service de Cardiologie, Pôle Cœur Thorax Vasculaire, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université François Rabelais, Tours, France (B.G., N.C., N.B., B.P., D.B., L.F.); and Division of Cardiology, Cardiac Electrophysiology, Mercy Hospital-North Iowa, Mason City, IA (B.O.)
| | - Bertrand Pierre
- From the Service de Cardiologie, Pôle Cœur Thorax Vasculaire, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université François Rabelais, Tours, France (B.G., N.C., N.B., B.P., D.B., L.F.); and Division of Cardiology, Cardiac Electrophysiology, Mercy Hospital-North Iowa, Mason City, IA (B.O.)
| | - Dominique Babuty
- From the Service de Cardiologie, Pôle Cœur Thorax Vasculaire, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université François Rabelais, Tours, France (B.G., N.C., N.B., B.P., D.B., L.F.); and Division of Cardiology, Cardiac Electrophysiology, Mercy Hospital-North Iowa, Mason City, IA (B.O.)
| | - Brian Olshansky
- From the Service de Cardiologie, Pôle Cœur Thorax Vasculaire, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université François Rabelais, Tours, France (B.G., N.C., N.B., B.P., D.B., L.F.); and Division of Cardiology, Cardiac Electrophysiology, Mercy Hospital-North Iowa, Mason City, IA (B.O.)
| | - Laurent Fauchier
- From the Service de Cardiologie, Pôle Cœur Thorax Vasculaire, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université François Rabelais, Tours, France (B.G., N.C., N.B., B.P., D.B., L.F.); and Division of Cardiology, Cardiac Electrophysiology, Mercy Hospital-North Iowa, Mason City, IA (B.O.)
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Real-world characteristics of hospitalized frail elderly patients with atrial fibrillation: can we improve the current prescription of anticoagulants? JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2016; 13:226-32. [PMID: 27103917 PMCID: PMC4826892 DOI: 10.11909/j.issn.1671-5411.2016.03.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND In elderly patients, especially those older than 80 years, atrial fibrillation (AF) is associated with an almost 25% increased risk of stroke. Stroke prophylaxis with anticoagulants is therefore highly recommended. The prevalence of factors that have been associated with a lower rate of prescription and adherence to anticoagulant therapy in these patients is little known. The objective of this study was to explore the clinical characteristics of elderly subjects, with and without AF, consecutively admitted to an acute geriatric unit, discussing factors that may decrease the persistence on stroke prophylaxis therapy. We also highlight possible strategies to overcome the barriers conditioning the current underuse of oral anticoagulants in this segment of the population. METHODS A retrospective observational study was performed on a cohort of elderly patients with and without AF admitted to the Acute Geriatric Unit of San Gerardo Hospital (Monza, Italy). RESULTS Compared to patients without AF (n = 1216), those with AF (n = 403) had a higher Charlson Comorbidity Index (3 vs. 2, P < 0.001), number of administered drugs (4 vs. 3, P < 0.001), rate of heart failure (36.5% vs. 12%, P < 0.001) and chronic kidney disease (20.6 vs. 13.2, P < 0.001). Many patients with AF were frail (54%) or pre-frail (29%). CONCLUSIONS Elderly patients with AF have higher rates of conditions that affect adherence to traditional anticoagulant therapy (vitamin K antagonists, VKA). New direct oral anticoagulants (DOAs) can help overcome this problem. In order to prescribe the most appropriate VKA or DOAs, with the best efficacy/safety profile and the highest compliance, a comprehensive geriatric assessment should always accompany the scores for thrombotic and hemorrhagic risk stratification.
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Utilization and Clinical Feasibility of a Handheld Remote Electrocardiography Recording Device in Cardiac Arrhythmias and Atrial Fibrillation: A Pilot Study. INT J GERONTOL 2015. [DOI: 10.1016/j.ijge.2015.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Lourenço P, Ribeiro A, Cunha FM, Pintalhão M, Marques P, Cunha F, Silva S, Bettencourt P. Is there a heart rate paradox in acute heart failure? Int J Cardiol 2015; 203:409-14. [PMID: 26544063 DOI: 10.1016/j.ijcard.2015.10.129] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 09/22/2015] [Accepted: 10/18/2015] [Indexed: 01/01/2023]
Abstract
BACKGROUND Higher heart rate predicts higher mortality in chronic heart failure (HF). We studied the prognostic impact of admission heart rate in acute HF and analysed the importance of its change during hospitalization. METHODS Acute HF patients were studied. Endpoint was all-cause death. Patients were followed-up for 12 months from hospital admission. Cox-regression analysis was used to study the association of heart rate (both as a continuous and as a categorical variable) with mortality. Analysis was stratified according to admission rhythm and to systolic dysfunction. Multivariate models were built. Patients surviving hospitalization were additionally cross-classified attending to admission and discharge heart rates – cut-offs: 100 and 80 beats per minute (bpm), respectively. RESULTS We analysed 564 patients. Median age was 78 years and median admission heart rate 87 bpm. In a 12-month period 205 patients died, 23 in-hospital. Mortality increased steadily with heart rate decrease. Patients with heart rate ≥ 100 bpm had a multivariate-adjusted HR of 12-month death of 0.57 (95%CI: 0.39-0.81), and the HR was 0.92 (0.85-0.98) per 10 bpm increase in heart rate. Association of heart rate with mortality was stronger in patients in sinus rhythm (SR) and in those with systolic dysfunction. Eighty-seven patients had admission heart rate ≥ 100 and discharge heart rate < 80 bpm. In them, death rate was 14.9%; in the remaining patients it was 37.7%. CONCLUSIONS Higher admission heart rate predicted survival advantage in acute HF. Patients presenting with tachycardia and discharged with a controlled heart rate had better outcome than those admitted non-tachycardic or discharged with a non-controlled heart rate.
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Affiliation(s)
- Patrícia Lourenço
- Serviço de Medicina Interna, Centro Hospitalar São João, Porto, Portugal.
| | - Ana Ribeiro
- Serviço de Medicina Interna, Centro Hospitalar São João, Porto, Portugal
| | - Filipe M Cunha
- Serviço de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar São João, Porto, Portugal
| | - Mariana Pintalhão
- Serviço de Medicina Interna, Centro Hospitalar São João, Porto, Portugal; Faculdade de Medicina da Universidade do Porto; Unidade I&D Cardiovascular do Porto, Portugal
| | - Pedro Marques
- Serviço de Medicina Interna, Centro Hospitalar São João, Porto, Portugal
| | - Francisco Cunha
- Serviço de Medicina Interna, Centro Hospitalar São João, Porto, Portugal
| | - Sérgio Silva
- Serviço de Medicina Interna, Centro Hospitalar São João, Porto, Portugal
| | - Paulo Bettencourt
- Serviço de Medicina Interna, Centro Hospitalar São João, Porto, Portugal; Faculdade de Medicina da Universidade do Porto; Unidade I&D Cardiovascular do Porto, Portugal
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Paolillo S, Agostoni P, Masarone D, Corrà U, Passino C, Scrutinio D, Correale M, Cattadori G, Metra M, Girola D, Piepoli MF, Salvioni E, Giovannardi M, Iorio A, Emdin M, Raimondo R, Re F, Cicoira M, Belardinelli R, Guazzi M, Clemenza F, Parati G, Scardovi AB, Di Lenarda A, La Gioia R, Frigerio M, Lombardi C, Gargiulo P, Sinagra G, Pacileo G, Perrone-Filardi P, Limongelli G. Prognostic role of atrial fibrillation in patients affected by chronic heart failure. Data from the MECKI score research group. Eur J Intern Med 2015; 26:515-20. [PMID: 26026698 DOI: 10.1016/j.ejim.2015.04.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Revised: 04/22/2015] [Accepted: 04/27/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) is common in heart failure (HF). It is unclear whether AF has an independent prognostic role in HF. The aim of the present study was to assess the prognostic role of AF in HF patients with reduced ejection fraction (EF). METHODS HF patients were followed in 17 centers for 3.15years (1.51-5.24). Study endpoints were the composite of cardiovascular (CV) death and heart transplant (HTX) and all-cause death. Data analysis was performed considering the entire population and a 1 to 1 match between sinus rhythm (SR) and AF patients. Match process was done for age±5, gender, left ventricle EF±5, peakVO2±3 (ml/min/kg) and recruiting center. RESULTS A total of 3447 patients (SR=2882, AF=565) were included in the study. Considering the entire population, CV death and HTX occurred in 114 (20%) AF vs. 471 (16%) SR (p=0.026) and all-cause death in 130 (23%) AF vs. 554 (19.2%) SR patients (p=0.039). At univariable Cox analysis, AF was significantly related to prognosis. Applying a multivariable model based on all variables significant at univariable analysis (EF, peakVO2, ventilation/carbon dioxide relationship slope, sodium, kidney function, hemoglobin, beta-blockers and digoxin) AF was no longer associated with adverse outcomes. Matching procedure resulted in 338 couples. CV death and HTX occurred in 63 (18.6%) AF vs. 74 (21.9%) SR (p=0.293) and all-cause death in 71 (21%) AF vs. 80 (23.6%) SR (p=0.406), with no survival differences between groups. CONCLUSION In systolic HF AF is a marker of disease severity but not an independent prognostic indicator.
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Affiliation(s)
- Stefania Paolillo
- Department of Advanced Biomedical Sciences, "Federico II" University, Napoli, Italy
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Milano, Italy; Department of Clinical Sciences and Community Health, Università di Milano, Milano, Italy.
| | - Daniele Masarone
- Cardiologia SUN, Ospedale Monaldi (Azienda dei Colli), Seconda Università di Napoli, Napoli, Italy
| | - Ugo Corrà
- Divisione di Cardiologia Riabilitativa, Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Veruno, Veruno, Italy
| | - Claudio Passino
- Fondazione Gabriele Monasterio, CNR-Regione Toscana, Pisa, Italy; Scuola Superiore S. Anna, Pisa, Italy
| | - Domenico Scrutinio
- Division of Cardiology, "S. Maugeri" Foundation, IRCCS, Institute of Cassano Murge, Bari, Italy
| | | | | | - Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Davide Girola
- Dipartimento Cardiologico "A. De Gasperis", Ospedale Cà Granda-A.O. Niguarda, Milano, Italy
| | | | | | | | - Annamaria Iorio
- Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy
| | - Michele Emdin
- Fondazione Gabriele Monasterio, CNR-Regione Toscana, Pisa, Italy
| | - Rosa Raimondo
- Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Tradate, Dipartimento di Medicina e Riabilitazione Cardiorespiratoria Unità Operativa di Cardiologia Riabilitativa, Tradate, Varese, Italy
| | - Federica Re
- Cardiology Division, Cardiac Arrhythmia Center and Cardiomyopathies Unit, San Camillo-Forlanini Hospital, Roma, Italy
| | | | | | - Marco Guazzi
- Heart Failure Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Francesco Clemenza
- Heart Failure Unit, ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
| | - Gianfranco Parati
- Department of Health Science, University of Milano Bicocca & Department of Cardiology, San Luca Hospital, Istituto Auxologico Italiano, Milano, Italy
| | | | - Andrea Di Lenarda
- Centro Cardiovascolare, Azienda per i Servizi Sanitari no. 1, Trieste, Italy
| | - Rocco La Gioia
- Division of Cardiology, "S. Maugeri" Foundation, IRCCS, Institute of Cassano Murge, Bari, Italy
| | - Maria Frigerio
- Dipartimento Cardiologico "A. De Gasperis", Ospedale Cà Granda-A.O. Niguarda, Milano, Italy
| | - Carlo Lombardi
- Department of Cardiology, University of Foggia, Foggia, Italy
| | - Paola Gargiulo
- SDN Foundation, Institute of Diagnostic and Nuclear Development, Napoli, Italy
| | - Gianfranco Sinagra
- Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy
| | - Giuseppe Pacileo
- Cardiologia SUN, Ospedale Monaldi (Azienda dei Colli), Seconda Università di Napoli, Napoli, Italy
| | | | - Giuseppe Limongelli
- Cardiologia SUN, Ospedale Monaldi (Azienda dei Colli), Seconda Università di Napoli, Napoli, Italy
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A Systematic Review on the Progression of Paroxysmal to Persistent Atrial Fibrillation. JACC Clin Electrophysiol 2015; 1:105-115. [DOI: 10.1016/j.jacep.2015.04.010] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 04/10/2015] [Indexed: 11/20/2022]
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Abstract
Pharmacological treatment of atrial fibrillation in the context of heart failure poses numerous challenges. Management decisions are limited by contraindications to several drugs and the paucity of robust clinical trials that provide evidence-based guidance. This review proposes a structured action plan for managing atrial fibrillation coexisting with heart failure that considers published clinical guidelines and integrates recent data derived from substudies of randomized trials, including the atrial fibrillation and congestive heart failure (AF-CHF) trial. Areas of uncertainty, such as target heart rates in atrial fibrillation and upstream therapies, are also discussed.
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Lip GY, Laroche C, Popescu MI, Rasmussen LH, Vitali-Serdoz L, Dan GA, Kalarus Z, Crijns HJ, Oliveira MM, Tavazzi L, Maggioni AP, Boriani G. Heart failure in patients with atrial fibrillation in Europe: a report from the EURObservational Research Programme Pilot survey on Atrial Fibrillation. Eur J Heart Fail 2015; 17:570-82. [DOI: 10.1002/ejhf.254] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 01/23/2015] [Accepted: 01/29/2015] [Indexed: 11/11/2022] Open
Affiliation(s)
- Gregory Y.H. Lip
- University of Birmingham Centre for Cardiovascular Sciences; City Hospital; Birmingham UK
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine; Aalborg University; Aalborg Denmark
| | - Cécile Laroche
- EURObservational Research Programme Department, European Society of Cardiology; Sophia Antipolis; France
| | - Mircea I. Popescu
- Cardiology Department, Faculty of Medicine Oradea; Emergency Clinical County Hospital of Oradea; Romania
| | - Lars H. Rasmussen
- Department of Cardiology, Cardiovascular Research Centre; Aalborg University Hospital; Aalborg Denmark
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Medicine; Aalborg University; Aalborg Denmark
| | - Laura Vitali-Serdoz
- University of Trieste, Ospedale di Cattinara; AOU Ospedali Riuniti SC Cardiologia; Trieste Italy
| | | | - Zbigniew Kalarus
- Department of Cardiology; Silesian Center for Heart Disease; Zabrze Poland
| | - Harry J.G.M. Crijns
- Department of Cardiology; Maastricht University Medical Centre; Maastricht The Netherlands
| | - Mario M. Oliveira
- Cardiology Department; Santa Marta Hospital and Institute of Physiology, Faculty of Medicine, University of Lisbon; Lisbon Portugal
| | - Luigi Tavazzi
- Maria Cecilia Hospital; GVM Care and Research, Ettore Sansavini Health Science Foundation; Cotignola Italy
| | - Aldo P. Maggioni
- EURObservational Research Programme Department, European Society of Cardiology; Sophia Antipolis; France
| | - Giuseppe Boriani
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine; University of Bologna, S. Orsola-Malpighi University Hospital; Bologna Italy
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Hamaguchi S, Kinugawa S, Matsushima S, Fukushima A, Yokota T, Sakakibara M, Yokoshiki H, Tsuchihashi-Makaya M, Tsutsui H. Clinical characteristics and CHADS2 score in patients with heart failure and atrial fibrillation: Insights from the Japanese Cardiac Registry of Heart Failure in Cardiology (JCARE-CARD). Int J Cardiol 2014; 176:239-42. [DOI: 10.1016/j.ijcard.2014.06.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 06/28/2014] [Indexed: 10/25/2022]
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Potpara TS, Polovina MM, Licina MM, Marinkovic JM, Lip GYH. Predictors and prognostic implications of incident heart failure following the first diagnosis of atrial fibrillation in patients with structurally normal hearts: the Belgrade Atrial Fibrillation Study. Eur J Heart Fail 2014; 15:415-24. [DOI: 10.1093/eurjhf/hft004] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Tatjana S. Potpara
- Faculty of Medicine; University of Belgrade; Serbia
- Cardiology Clinic; Clinical Center of Serbia; Belgrade Serbia
| | | | | | - Jelena M. Marinkovic
- Institute for Medical Statistics, Faculty of Medicine; University of Belgrade; Belgrade Serbia
| | - Gregory Y. H. Lip
- University of Birmingham Centre for Cardiovascular Sciences; City Hospital; Birmingham B18 7QH UK
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Khan MA, Ahmed F, Neyses L, Mamas MA. Atrial fibrillation in heart failure: The sword of Damocles revisited. World J Cardiol 2013; 5:215-227. [PMID: 23888191 PMCID: PMC3722419 DOI: 10.4330/wjc.v5.i7.215] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2013] [Revised: 06/06/2013] [Accepted: 06/20/2013] [Indexed: 02/06/2023] Open
Abstract
Heart failure (HF) and atrial fibrillation (AF) frequently coexist and have emerged as major cardiovascular epidemics. There is growing evidence that AF is an independent prognostic marker in HF and affects patients with both reduced as well as preserved LV systolic function. There has been a general move in clinical practice from a rhythm control to a rate control strategy in HF patients with AF, although recent data suggests that rhythm control strategies may provide better outcomes in selected subgroups of HF patients. Furthermore, various therapeutic modalities including pace and ablate strategies with cardiac resynchronisation or radiofrequency ablation have become increasingly adopted, although their role in the management of AF in patients with HF remains uncertain. This article presents an overview of the multidimensional impact of AF in patients with HF. Relevant literature is highlighted and the effect of various therapeutic modalities on prognosis is discussed. Finally, while novel anticoagulants usher in a new era in thromboprophylaxis, research continues in a variety of new pathways including selective atrial anti-arrhythmic agents and genomic polymorphisms in AF with HF.
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Ferreira J, Ezekowitz MD, Connolly SJ, Brueckmann M, Fraessdorf M, Reilly PA, Yusuf S, Wallentin L. Dabigatran compared with warfarin in patients with atrial fibrillation and symptomatic heart failure: a subgroup analysis of the RE-LY trial. Eur J Heart Fail 2013; 15:1053-61. [PMID: 23843099 DOI: 10.1093/eurjhf/hft111] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS We evaluated the effects of dabigatran compared with warfarin in the subgroup of patients with previous symptomatic heart failure (HF) in the RE-LY trial. METHODS AND RESULTS RE-LY compared two fixed and blinded doses of dabigatran (110 and 150 mg twice daily) with open-label warfarin in 18 113 patients with AF at increased risk for stroke. Among 4904 patients with HF, annual rates of stroke or systemic embolism (SE) were 1.92% for patients on warfarin compared with 1.90% for dabigatran 110 mg [hazard ratio (HR) 0.99, 95% confidence interval (CI) 0.69-1.42] and 1.44% for dabigatran 150 mg (HR 0.75, 95% CI 0.51-1.10). Annual rates of major bleeding were 3.90% for the group on warfarin, compared with 3.26% for dabigatran 110 mg (HR 0.83, 95% CI 0.64-1.09) and 3.10% for dabigatran 150 mg (HR 0.79, 95% CI 0.60-1.03). Rates of intracranial bleeding were significantly lower for both dabigatran dosages compared with warfarin in patients with HF (dabigatran 110 mg vs. warfarin, HR 0.34, 95% CI 0.14-0.80; dabigatran 150 mg vs. warfarin, HR 0.39, 95% CI 0.17-0.89). The relative effects of dabigatran vs. warfarin on the occurrence of stroke or SE and major bleeding were consistent among those with and without HF and those with low (≤40%) or preserved (>40%) LVEF (P interaction not significant). CONCLUSIONS The overall benefits of dabigatran for stroke/SE prevention, and major and intracranial bleeding, relative to warfarin in the RE-LY trial were consistent in patients with and without HF.
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