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Atrial Fibrillation in Heart Failure With Preserved Ejection Fraction: The TOPCAT Trial

Maja Cikes1, Brian Claggett2, Amil M Shah2

  • 1Department of Cardiovascular Diseases, University of Zagreb School of Medicine, Zagreb, Croatia.

JACC. Heart Failure
|July 16, 2018
PubMed

Insights

Atrial fibrillation (AF) increases cardiovascular risk in heart failure with preserved ejection fraction (HFpEF). Spironolactone did not affect AF occurrence or treatment response, but new-onset AF significantly raised mortality risk.

Area of Science:

  • Cardiology
  • Clinical Trials
  • Electrophysiology

Background:

  • Atrial fibrillation (AF) is prevalent in heart failure with preserved ejection fraction (HFpEF).
  • AF is linked to adverse outcomes in HFpEF patients.
  • The impact of AF on spironolactone treatment response in HFpEF is not fully understood.

Purpose of the Study:

  • To assess the relationship between AF and outcomes in the TOPCAT trial.
  • To determine if AF modifies the treatment response to spironolactone.
  • To investigate if spironolactone influences the development of post-randomization AF.

Main Methods:

  • Analysis of 1,765 patients from the TOPCAT trial, categorized by AF status (no known AF, history of AF, AF at enrollment).
  • Assessment of cardiovascular outcomes and spironolactone treatment response across AF groups.
  • Evaluation of post-randomization AF incidence and its association with outcomes in AF-free patients.

Main Results:

  • 43% of patients had AF history or AF at enrollment.
  • AF at enrollment was associated with a 34% increased risk of the primary composite outcome (cardiovascular mortality, aborted cardiac arrest, HF hospitalization).
  • Spironolactone's benefit was not modified by AF status; spironolactone did not influence post-randomization AF, which increased early risk of primary outcomes (HR 2.32).

Conclusions:

  • AF at enrollment is a significant predictor of increased cardiovascular risk in HFpEF patients within the TOPCAT study.
  • Post-randomization AF independently increases morbidity and mortality risk.
  • Spironolactone treatment did not impact AF development or its associated risks.
Abstract

Keywords:
atrial fibrillationechocardiographyheart failure outcomesheart failure with preserved ejection fractionspironolactone

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