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Published on: February 26, 2013
Relative Importance of Heart Failure Events Compared to Stroke and Bleeding in AF Patients
Sandro Ninni1, Gilles Lemesle1, Thibaud Meurice2
1Institut Cœur Poumon, University of Lille, CHU Lille, 59000 Lille, France.
Insights
Heart failure (HF) is a common and fatal complication in atrial fibrillation (AF) patients. Intensive management of modifiable risk factors like diabetes and hypertension is crucial for preventing HF in AF patients.
Area of Science:
- Cardiology
- Internal Medicine
- Public Health
Background:
- Atrial fibrillation (AF) patients face high risks of heart failure (HF), stroke, and bleeding.
- Current anticoagulation therapies aim to mitigate these risks but residual events remain a concern.
Purpose of the Study:
- To determine the 3-year incidence of HF, ischemic stroke/systemic embolism (IS/SE), and major bleeding in AF outpatients.
- To identify predictors of these adverse events and their impact on mortality.
- To assess HF as a residual cardiovascular event in AF patients.
Main Methods:
- Analysis of 4973 AF outpatients from the CARDIONOR registry.
- Median follow-up of 3.2 years.
- Statistical analysis to identify predictors and mortality associations.
Main Results:
- The 3-year incidence was 10.5% for HF, 3.3% for IS/SE, and 2.1% for major bleeding.
- HF, IS/SE, and major bleeding were all associated with increased mortality.
- Independent predictors for HF included age, female sex, hypertension, diabetes, coronary artery disease, and prior HF history.
Conclusions:
- Heart failure is a frequent and highly fatal residual adverse event in AF outpatients.
- Modifiable risk factors are linked to incident HF, suggesting intensive management is warranted.
- Targeting modifiable risk factors may reduce HF incidence and improve outcomes in AF patients.
Introduction:
Incident heart failure (HF), ischemic stroke and systemic embolism (IS/SE), and major bleeding related to anticoagulation therapy are still the most frequent events occurring in patients with atrial fibrillation (AF). The aim of this study was to assess the 3-year incidence, predictors, and related mortality of IS/SE, major bleeding, and HF in a large cohort of AF outpatients.
Methods And Results:
We studied 4973 outpatients with prevalent AF included in the CARDIONOR registry. The mean age was 72.9 ± 11.2 years, 24.1% had diabetes mellitus and 78.9% had anticoagulant therapy at baseline. The mean CHA2DS2Vasc score was 3.4 ± 1.7. After a median follow-up of 3.2 years (IQR: 2.8 to 3.5), incident HF, IS/SE and major bleeding occurred in 10.5%, 3.3% and 2.1% of patients, respectively. When analyzed as time-dependent variables, IS/SE, major bleeding and hospitalization for decompensated HF were all strongly associated with mortality. The independent predictors of incident HF were age, women, hypertension, diabetes mellitus, coronary artery disease and a previous history of HF. A sensitivity analysis in patients without history of HF at inclusion revealed that incident HF remained the most frequent adverse event, occurring in 5.3% of patients, compared to IS/SE (1.7%) and major bleeding (2.5%).
Conclusion:
HF is a common residual cardiovascular adverse event occurring in AF outpatients and is associated with a very high mortality. Since modifiable risk factors are associated with incident HF, upstream intensive management of these risk factors would be of interest.
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