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Subclinical atrial fibrillation and the risk of heart failure: insights from ARTESiA
Maria Hee Jung Park Frausing1,2,3, William F McIntyre4, Jeff S Healey4
1Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Bvld. 99, Aarhus N DK-8200, Denmark.
Insights
Subclinical atrial fibrillation (SCAF) progression, not brief episodes, increases heart failure (HF) risk. Close monitoring of SCAF patients is crucial for early detection of HF events and improved outcomes.
Area of Science:
- Cardiology
- Electrophysiology
- Heart Failure Research
Background:
- Clinical atrial fibrillation (AF) is linked to heart failure (HF).
- The association between device-detected subclinical atrial fibrillation (SCAF) and HF outcomes remains unclear.
- Understanding SCAF's impact on HF is vital for patient management.
Purpose of the Study:
- To determine the incidence of HF events in patients with SCAF.
- To identify clinical risk factors associated with HF events in SCAF patients.
- To analyze SCAF progression as a predictor of HF hospitalization or death.
Main Methods:
- Secondary analysis of the ARTESiA trial involving 3986 patients.
- Investigated SCAF episodes (≤24 hours) and their progression (>24 hours or clinical AF).
- Assessed SCAF characteristics as risk markers for HF hospitalization or HF-related death.
Main Results:
- SCAF progression occurred in 31% of patients over 4.1 years.
- HF hospitalization or HF-related death occurred in 13% of patients.
- SCAF progression independently increased the risk of HF hospitalization or death (HR 2.72).
Conclusions:
- HF hospitalization and death are significant concerns for patients with SCAF.
- Progression to longer SCAF episodes or clinical AF is linked to HF events.
- Brief SCAF episodes (<24 hours) were not associated with HF events, highlighting the need for vigilant SCAF patient surveillance.
Aims:
Heart failure (HF) and clinical atrial fibrillation are closely linked, but the relationship between device-detected subclinical atrial fibrillation (SCAF) and HF is unclear. We aimed to determine incidence and clinical risk factors for HF events among patients with SCAF.
Methods:
We included 3986 patients from the ARTESiA (Apixaban for the Reduction of Thromboembolism in Patients with Device-Detected Subclinical Atrial Fibrillation) trial. ARTESiA investigated the effect of apixaban versus aspirin for stroke prevention in patients with episodes of SCAF ≤24 hours. In this secondary analysis, we explored the number and duration of SCAF episodes at baseline as risk markers for HF hospitalization or HF-related death. SCAF progression was analysed as a time-dependent covariate and defined as the development of SCAF >24 hours or clinical atrial fibrillation.
Results:
Over a mean follow-up of 4.1 ± 1.7 years, SCAF progression was observed in 1244 patients (31%). Heart failure hospitalization or HF-related death occurred in 515 (13%) patients at a rate of 3.3 [95% confidence interval (CI) 3.1-3.6] per 100 person-years. A total of 172 HF-related events occurred after SCAF progression (7.2 events, 95% CI 6.2-8.3, per 100 PY). SCAF progression was an independent risk factor for HF hospitalization or HF-related death (hazard ratio 2.72, 95% CI 2.24-3.31).
Conclusion:
Heart failure hospitalization and HF-related death are common in patients with SCAF. Progression to longer SCAF episodes or clinical AF were associated with HF events, but episodes <24 h were not. These findings underscore the need for close surveillance of SCAF patients to detect complications and potentially improve outcomes.
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