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Type of Atrial Fibrillation and Outcomes in Patients With Heart Failure and Reduced Ejection Fraction
Journal of the American College of Cardiology ( IF 21.7 ) Pub Date : 2017-11-01 , DOI: 10.1016/j.jacc.2017.09.027
Ulrik M. Mogensen , Pardeep S. Jhund , William T. Abraham , Akshay S. Desai , Kenneth Dickstein , Milton Packer , Jean L. Rouleau , Scott D. Solomon , Karl Swedberg , Michael R. Zile , Lars Køber , John J.V. McMurray

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

中文翻译:

心力衰竭和射血分数降低患者的房颤类型和结果

背景 心房颤动 (AF) 在心力衰竭 (HF) 中很常见,但 AF 类型的结果在很大程度上是未知的。目的 本研究调查了最近 2 项针对射血分数降低的 HF 患者的大型试验中与 AF 类型(阵发性、持续性或永久性或新发性)相关的结果。方法 该研究分析了 PARADIGM-HF(ARNI 与 ACEI 的前瞻性比较,以确定对心力衰竭全球死亡率和发病率的影响)和 ATMOSPHERE(阿利吉仑试验,以最大限度地减少心力衰竭患者的预后)中的患者。多变量 Cox 回归模型用于估计与 AF 类型相关的结果的风险比 (HR)。结果 在 15,415 名患者中,5,481 (35.6%) 名患者在随机分组时有 AF 病史,其中 1,645 (30.0%) 名患者有阵发性 AF。与没有 AF 的患者相比,随机分组时阵发性房颤患者发生心血管死亡或心衰住院的主要复合终点风险较高(HR:1.20;95% 置信区间 [CI]:1.09 至 1.32;p < 0.001)、心衰住院(HR:1.34; 95% CI:1.19 至 1.51;p < 0.001)和中风(HR:1.34;95% CI:1.02 至 1.76;p = 0.037),而持续性或永久性 AF 患者的相应风险并未升高。两种类型的 AF 均与较高的死亡率无关。新发房颤与不良结局的最大风险相关:主要终点(HR:2.21;95% CI:1.80 至 2.71)、HF 住院(HR:2.11;95% CI:1.58 至 2.81)、中风(HR:2.20) ; 95% CI:1.25 至 3.88)和全因死亡率(HR:2.26;95% CI:1.86 至 2.74),与没有 AF 的患者相比,所有 p 值 < 0.001。与持续性或永久性 AF 患者 (71%) 相比,阵发性 (53%) 和新发 (16%) AF 患者使用抗凝剂的频率较低。结论 在有 AF 病史的 HF 患者中,阵发性 AF 患者的 HF 住院和卒中风险高于持续性或永久性 AF 患者,强调了抗凝治疗的重要性。新发 AF 与所有结果的风险增加有关。(ARNI 与 ACEI 的前瞻性比较,以确定对心力衰竭全球死亡率和发病率的影响 [PARADIGM-HF];NCT01035255)(阿利吉仑试验以最大限度地减少心力衰竭患者的结局 [ATMOSPHERE];NCT00853658)。与持续性或永久性 AF 患者相比,阵发性 AF 患者发生 HF 住院和中风的风险更高,这强调了抗凝治疗的重要性。新发 AF 与所有结果的风险增加有关。(ARNI 与 ACEI 的前瞻性比较,以确定对心力衰竭全球死亡率和发病率的影响 [PARADIGM-HF];NCT01035255)(阿利吉仑试验以最大限度地减少心力衰竭患者的结局 [ATMOSPHERE];NCT00853658)。与持续性或永久性 AF 患者相比,阵发性 AF 患者发生 HF 住院和中风的风险更高,这强调了抗凝治疗的重要性。新发 AF 与所有结果的风险增加有关。(ARNI 与 ACEI 的前瞻性比较,以确定对心力衰竭全球死亡率和发病率的影响 [PARADIGM-HF];NCT01035255)(阿利吉仑试验以最大限度地减少心力衰竭患者的结局 [ATMOSPHERE];NCT00853658)。
更新日期:2017-11-01
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