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Analysis of Outcomes in Ischemic vs Nonischemic Cardiomyopathy in Patients With Atrial Fibrillation: A Report From

Ramon Corbalan1, Jean-Pierre Bassand2,3, Laura Illingworth3

  • 1Division of Cardiovascular Diseases, Catholic University School of Medicine, Santiago, Chile.

JAMA Cardiology
|May 9, 2019
PubMed

Insights

Patients with congestive heart failure (CHF) and atrial fibrillation (AF) due to ischemic cardiomyopathy (ICM) had higher death and major bleeding rates than those with nonischemic cardiomyopathy (NICM). Treatment strategies varied between groups, impacting outcomes.

Area of Science:

  • Cardiology
  • Internal Medicine
  • Clinical Research

Background:

  • Congestive heart failure (CHF) frequently co-occurs with nonvalvular atrial fibrillation (AF).
  • The etiology of cardiomyopathy in patients with AF may influence treatment decisions and clinical outcomes.

Purpose of the Study:

  • To evaluate treatment strategies and 1-year clinical outcomes.
  • To compare outcomes between patients with newly diagnosed AF and CHF stratified by ischemic cardiomyopathy (ICM) versus nonischemic cardiomyopathy (NICM).

Main Methods:

  • Analysis of data from the prospective, noninterventional GARFIELD-AF registry (N=11,738).
  • Patients with newly diagnosed AF and CHF were categorized into ICM and NICM groups.
  • One-year follow-up assessed rates of death, stroke/systemic embolism, and major bleeding.

Main Results:

  • Patients with ICM received oral anticoagulants less frequently and antiplatelets alone more frequently than those with NICM.
  • Rates of all-cause death (10.2 vs 7.0 per 100 person-years) and cardiovascular death (5.1 vs 2.9 per 100 person-years) were significantly higher in the ICM group.
  • Major bleeding rates were also significantly higher in the ICM group (1.1 vs 0.7 per 100 person-years).

Conclusions:

  • Treatment patterns for antithrombotic and heart failure therapies differed between ICM and NICM patients.
  • Ischemic cardiomyopathy in patients with AF and CHF is associated with worse clinical outcomes, including higher mortality and bleeding risk.
  • These findings highlight the importance of considering cardiomyopathy etiology in managing patients with AF and CHF.
Abstract

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