TY - JOUR
T1 - Atrial Fibrillation can adversely impact Heart Failure with Preserved Ejection Fraction by its association with Heart Failure Progression and Mortality
T2 - A Post-Hoc Propensity Score–Matched Analysis of the TOPCAT Americas Trial
AU - Saksena, Sanjeev
AU - Slee, April
AU - Natale, Andrea
AU - Lakkireddy, Dhanunjaya R.
AU - Shah, Dipen
AU - Di Biase, Luigi
AU - Lewalter, Thorsten
AU - Nagarakanti, Rangadham
AU - Santangeli, Pasquale
N1 - Publisher Copyright:
. . . © The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.
PY - 2023/5/1
Y1 - 2023/5/1
N2 - Aims Prevalent atrial fibrillation (AF) is associated with excess cardiovascular (CV) death (D) and hospitalizations (H) in heart failure (HF) with preserved ejection fraction (pEF). We evaluated if it had an independent role in excess CVD in HFpEF and studied its impact on cause-specific mortality and HF morbidity. Methods We used propensity score–matched (PSM) cohorts from the TOPCAT Americas trial to account for confounding by other and results co-morbidities. Two prevalent AF presentations at study entry were compared: (i) subjects with Any AF event by history or on electrocardiogram (ECG) with PSM subjects without an AF event and (ii) subjects in AF on ECG with PSM subjects in sinus rhythm. We analyzed cause-specific modes of death and HF morbidity during a mean follow-up period of 2.9 years. A total of 584 subjects with Any AF event and 418 subjects in AF on ECG were matched. Any AF was associated with increased CVH [hazard ratio (HR) 1.33, 95% confidence interval (CI) 1.11–1.61, P = 0.003], HFH (HR 1.44, 95% CI 1.12–1.86, P = 0.004), pump failure death (PFD) (HR 1.95, 95% CI 1.05–3.62, P = 0.035), and HF progression from New York Heart Association (NYHA) classes I/II to III/IV (HR 1.30, 95% CI 1.04–1.62, P = 0.02). Atrial fibrillation on ECG was associated with increased risk of CVD (HR 1.46, 95% CI 1.02–2.09, P = 0.039), PFD (HR 2.21, 95% CI 1.11–4.40, P = 0.024), and CVH and HFH (HR 1.37, 95% CI 1.09–1.72, P = 0.006 and HR 1.65, 95% CI 1.22–2.23, P = 0.001, respectively). Atrial fibrillation was not associated with risk of sudden death. Both Any AF and AF on ECG cohorts were associated with PFD in NYHA class III/IV HF. Conclusion Prevalent AF can be an independent risk factor for adverse CV outcomes by its selective association with worsening HF, HFH, and PFD in HFpEF. Prevalent AF was not associated with excess sudden death risk in HFpEF. Atrial fibrillation was also associated with HF progression in early symptomatic HFpEF and PFD in advanced HFpEF. Trial registration TOPCAT trial is registered at www.clinicaltrials.gov:identifier NCT00094302.
AB - Aims Prevalent atrial fibrillation (AF) is associated with excess cardiovascular (CV) death (D) and hospitalizations (H) in heart failure (HF) with preserved ejection fraction (pEF). We evaluated if it had an independent role in excess CVD in HFpEF and studied its impact on cause-specific mortality and HF morbidity. Methods We used propensity score–matched (PSM) cohorts from the TOPCAT Americas trial to account for confounding by other and results co-morbidities. Two prevalent AF presentations at study entry were compared: (i) subjects with Any AF event by history or on electrocardiogram (ECG) with PSM subjects without an AF event and (ii) subjects in AF on ECG with PSM subjects in sinus rhythm. We analyzed cause-specific modes of death and HF morbidity during a mean follow-up period of 2.9 years. A total of 584 subjects with Any AF event and 418 subjects in AF on ECG were matched. Any AF was associated with increased CVH [hazard ratio (HR) 1.33, 95% confidence interval (CI) 1.11–1.61, P = 0.003], HFH (HR 1.44, 95% CI 1.12–1.86, P = 0.004), pump failure death (PFD) (HR 1.95, 95% CI 1.05–3.62, P = 0.035), and HF progression from New York Heart Association (NYHA) classes I/II to III/IV (HR 1.30, 95% CI 1.04–1.62, P = 0.02). Atrial fibrillation on ECG was associated with increased risk of CVD (HR 1.46, 95% CI 1.02–2.09, P = 0.039), PFD (HR 2.21, 95% CI 1.11–4.40, P = 0.024), and CVH and HFH (HR 1.37, 95% CI 1.09–1.72, P = 0.006 and HR 1.65, 95% CI 1.22–2.23, P = 0.001, respectively). Atrial fibrillation was not associated with risk of sudden death. Both Any AF and AF on ECG cohorts were associated with PFD in NYHA class III/IV HF. Conclusion Prevalent AF can be an independent risk factor for adverse CV outcomes by its selective association with worsening HF, HFH, and PFD in HFpEF. Prevalent AF was not associated with excess sudden death risk in HFpEF. Atrial fibrillation was also associated with HF progression in early symptomatic HFpEF and PFD in advanced HFpEF. Trial registration TOPCAT trial is registered at www.clinicaltrials.gov:identifier NCT00094302.
KW - Antiarrhythmic therapy
KW - Arrhythmias
KW - Atrial fibrillation
KW - Cardiovascular mortality
KW - Clinical trials
KW - Heart failure with preserved ejection fraction
KW - Outcomes research
KW - Sudden death
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U2 - 10.1093/europace/euad095
DO - 10.1093/europace/euad095
M3 - Article
C2 - 37078691
AN - SCOPUS:85160875490
SN - 1099-5129
VL - 25
JO - Europace
JF - Europace
IS - 5
M1 - euad095
ER -