Comparative effectiveness of bisoprolol and carvedilol among patients receiving maintenance hemodialysis

Abstract Background Despite widespread use, there is no trial evidence to inform β-blocker’s (BB) relative safety and efficacy among patients undergoing hemodialysis (HD). We herein compare health outcomes associated with carvedilol or bisoprolol use, the most commonly prescribed BBs in these patients. Methods We created a cohort study of 9305 HD patients who initiated bisoprolol and 11 171 HD patients who initiated carvedilol treatment between 2004 and 2011. We compared the risk of all-cause mortality and major adverse cardiovascular events (MACEs) between carvedilol and bisoprolol users during a 2-year follow-up. Results Bisoprolol initiators were younger, had shorter dialysis vintage, were women, had common comorbidities of hypertension and hyperlipidemia and were receiving statins and antiplatelets, but they had less heart failure and digoxin prescriptions than carvedilol initiators. During our observations, 1555 deaths and 5167 MACEs were recorded. In the multivariable-adjusted Cox model, bisoprolol initiation was associated with a lower all-cause mortality {hazard ratio [HR] 0.66 [95% confidence interval (CI) 0.60–0.73]} compared with carvedilol initiation. After accounting for the competing risk of death, bisoprolol use (versus carvedilol) was associated with a lower risk of MACEs [HR 0.85 (95% CI 0.80–0.91)] and attributed to a lower risk of heart failure [HR 0.83 (95% CI 0.77–0.91)] and ischemic stroke [HR 0.84 (95% CI 0.72–0.97)], but not to differences in the risk of acute myocardial infarction [HR 1.03 (95% CI 0.93–1.15)]. Results were confirmed in propensity score matching analyses, stratified analyses and analyses that considered prescribed dosages or censored patients discontinuing or switching BBs. Conclusions Relative to carvedilol, bisoprolol initiation by HD patients was associated with a lower 2-year risk of death and MACEs, mainly attributed to lower heart failure and ischemic stroke risk.

Download Full-text

Sex disparity in subsequent outcomes in survivors of coronary heart disease

Heart ◽

10.1136/heartjnl-2021-319566 ◽

2021 ◽

pp. heartjnl-2021-319566

Author(s):

Ralph Kwame Akyea ◽

Evangelos Kontopantelis ◽

Joe Kai ◽

Stephen F Weng ◽

Riyaz S Patel ◽

...

Keyword(s):

Heart Failure ◽

Coronary Heart Disease ◽

Heart Disease ◽

Lower Risk ◽

Hazard Ratio ◽

Practice Research ◽

Major Adverse Cardiovascular Events ◽

Prior History ◽

Clinical Practice Research Datalink ◽

All Cause Mortality

ObjectiveEvidence on sex differences in outcomes after developing coronary heart disease (CHD) has focused on recurrent CHD, all-cause mortality or revascularisation. We assessed sex disparities in subsequent major adverse cardiovascular events (MACE) in adults surviving their first-time CHD.MethodsUsing a population-based cohort obtained from the Clinical Practice Research Datalink (CPRD GOLD) linked to hospitalisation and death records in the UK, we identified 143 702 adults (aged ≥18 years) between 1 January 1998 and 31 December 2017 with no prior history of MACE. MACE outcome was a composite of recurrent CHD, stroke, peripheral vascular disease, heart failure and cardiovascular-related mortality. Multivariable models (Cox and competing risks regressions) were used to assess differences between sexes.ResultsThere were 143 702 adults with any incident CHD (either angina, myocardial infarction or coronary revascularisation). Women (n=63 078, 43.9%) were older than men (median age, 73 vs 66 years). First subsequent MACE outcome was observed in 91 706 (63.8%). Women had a significantly lower risk of MACE (hazard ratio (HR), 0.68 (95% CI 0.67 to 0.69); sub-hazard ratio (HRsd), 0.71 (0.70 to 0.72), respectively) and recurrent CHD (n=66 543, 46.3%) (HR, 0.60 (0.59 to 0.61); HRsd, 0.62 (0.61 to 0.63)) when compared with men after incident CHD. However, women had a significantly higher risk of stroke (n=5740, 4.0%) (HR, 1.26 (1.19 to 1.33); HRsd, 1.32 (1.25 to 1.39)), heart failure (n=7905, 5.5%) (HR, 1.09 (1.04 to 1.15); HRsd, 1.13 (1.07 to 1.18)) and all-cause mortality (n=29 503, 20.5%) (HR, 1.05 (1.02 to 1.07); HRsd, 1.11 (1.08 to 1.13)).ConclusionsAfter incident CHD, women have lower risk of composite MACE and recurrent CHD outcomes but higher risk of stroke, heart failure, and all-cause mortality compared with men.

Download Full-text

Abstract 4331: Elevated Albumin Excretion is an Independent Risk Factor in Patients with Chronic Heart Failure. Data from the GISSI-Heart Failure Trial

Circulation ◽

10.1161/circ.118.suppl_18.s_866 ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Serge Masson ◽

Luciano Moretti ◽

Ospedale Mazzoni ◽

Maria Grazia Rossi ◽

Emanuele Carbonieri ◽

...

Keyword(s):

Heart Failure ◽

Renal Function ◽

Risk Factor ◽

Independent Risk Factor ◽

Cox Model ◽

Nyha Class ◽

Large Population ◽

Creatinine Concentration ◽

Albumin Excretion ◽

All Cause Mortality

Elevated albuminuria, a marker of endothelial renal damage, is a risk factor for cardiovascular events in the general population and in patients with diabetes or hypertension. We report here on its association with mortality in a large population of patients with chronic HF. Albuminuria (albumin/creatinine concentration ratio in a morning spot sample, UACR) was determined in 2131 patients with chronic HF enrolled in 77 centers participating to the GISSI-HF trial. Patients were divided according to normal (UACR <30 mg/g) and abnormal urinary excretion of albumin (≥30 mg/g). Association between elevated albuminuria and all-cause mortality was tested by univariable and multivariable analyses. Elevated albuminuria was found in 25.3% of the population (age 67±11 y, 78.9% males, 30.1% NYHA class III-IV, 55.5% hypertension, 26.1% diabetes) and was more frequent in older patients, those with reduced renal function, diabetes or high CRP. Mortality was significantly higher in patients with elevated albuminuria (20.1% at 1000 days) compared to normals (9.0%, p<0.0001). Elevated albuminuria remained an independent risk factor for all-cause mortality (HR [95%CI] 1.47 [1.18 –1.82]) in a Cox model adjusted for clinical risk factors such as age, gender, NYHA class, renal function, diabetes, BMI and blood pressure. About a quarter of the patients enrolled in the GISSI-HF trial had abnormal urinary albumin excretion, a marker for both renal and systemic vascular disease. We show for the first time in a large representative sample that elevated albuminuria is an independent predictor of all-cause mortality in patients with chronic HF.

Download Full-text

Abstract 392: Warfarin Versus Aspirin in Patients with Systolic Heart Failure and Normal Sinus Rhythm: Insights From a Meta-Analysis

Arteriosclerosis Thrombosis and Vascular Biology ◽

10.1161/atvb.34.suppl_1.392 ◽

2014 ◽

Vol 34 (suppl_1) ◽

Author(s):

Rachit Shah ◽

George Mueller ◽

Dhavalkumar Patel ◽

Janos Molnar ◽

Kalpesh Patel ◽

...

Keyword(s):

Heart Failure ◽

Ischemic Stroke ◽

Relative Risk ◽

Sinus Rhythm ◽

Systolic Heart Failure ◽

Aspirin Therapy ◽

Major Hemorrhage ◽

Risk Of Death ◽

Number Of Patients ◽

Aspirin Group

Background: It is unknown whether warfarin or aspirin therapy is superior for the treatment of patients with systolic heart failure who are in sinus rhythm. Methods: We performed a systematic literature search for randomized trials comparing warfarin and aspirin in patients with systolic heart failure which provided the event rates for ischemic stroke, major hemorrhage and death in the two groups. Heterogeneity of the studies was analyzed by Q statistics. The studies were homogeneous for each outcome; therefore the fixed-effect model was used to compute the relative risk based on the number of events and total number of patients in each group. A two-sided alpha error of <0.05 was considered to be statistically significant (p<0.05). Results: We found 4 randomized clinical trials comparing warfarin and aspirin therapy in patients with systolic heart failure with a mean duration of follow up of 2.3 years enrolling a total of 3663 patients. The relative risk for ischemic stroke in patients treated with warfarin was 0.50 with 95% confidence interval (CI) of 0.33 - 0.75 (P= 0.001) while the relative risk for major hemorrhage was 1.94 with 95% CI of 1.40- 2.71 (P= 0.000) in comparison to the aspirin group. The relative risk of death was 1.01 with 95% CI of 0.89- 1.14 (P= 0.871) in the warfarin group compared to the aspirin group. Conclusion: Although warfarin therapy appears to reduce the risk of ischemic stroke in patients with systolic heart failure who are in sinus rhythm, the reduction comes at the cost of higher risk of bleeding and there is no evidence of an overall benefit on mortality.

Download Full-text

Abstract P609: Restarting Anticoagulant Therapy After Intracranial Hemorrhage With Atrial Fibrillation: A Nationwide Retrospective Cohort Study

Stroke ◽

10.1161/str.52.suppl_1.p609 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Dong Hoon Shin ◽

Jaehun Jung ◽

Gi Hwan Bae

Keyword(s):

Atrial Fibrillation ◽

Cohort Study ◽

Retrospective Cohort Study ◽

Lower Risk ◽

Retrospective Cohort ◽

Antiplatelet Agents ◽

Risk Of Death ◽

Hemorrhagic Events ◽

All Cause Mortality ◽

Severe Hemorrhage

Background: Atrial fibrillation (AF) should be treated with anticoagulants to prevent stroke and systemic embolism. Resuming anticoagulation after intracerebral hemorrhage (ICH) poses a clinical conundrum. The absence of evidence-based guidelines to address this issue has led to wide variations in restarting anticoagulation after ICH. This study aimed to evaluate the risks and benefits of anticoagulation therapy on all-cause mortality, severe thromboembolism, and severe hemorrhage and compare the effect of novel direct oral anticoagulants (NOACs) with warfarin on post-ICH mortality in patients with AF. Methods: This retrospective cohort study was performed using health insurance claim data obtained between 2002 and 2017 from individuals with newly developed ICH with comorbid AF. We excluded participants aged < 40 years and those with traumatic ICH, subdural hemorrhage, or subarachnoid hemorrhage. The primary endpoint was all-cause mortality, and the secondary endpoints were severe thrombotic and hemorrhagic events. Anticoagulants, antiplatelet agents, and non-users were analyzed for survival with propensity score matching. Results: Among 6735 participants, 1743 (25.9%) and 1690 (25.1%) used anticoagulants and antiplatelet agents, respectively. Anticoagulant (HR, 0.321; 95% CI, 0.264-0.390; P < 0.0001) or antiplatelet users (HR, 0.393; 95% CI, 0.330-0.468; P < 0.0001) had a lower risk of all-cause mortality than non-users. However, there was no difference between the two drug users (HR, 1.183; 95% CI, 0.94-1.487; P = 0.152; reference: anticoagulant). The risk of acute thrombotic events, although not hemorrhagic events, was significantly lower in anticoagulant users than in antiplatelet users. In addition, anticoagulation between 6 to 8 weeks post-ICH showed a tendency of the lowest risk of death. Further, NOACs were associated with a lower risk of all-cause mortality than warfarin. Conclusions: Our results showed that in patients with AF, resuming anticoagulants between 6 and 8 weeks after ICH improved all-cause mortality, severe thromboembolism, and severe hemorrhage. Further, compared with warfarin, NOAC had additional benefits.

Download Full-text

Clustering of healthy lifestyle behaviors is associated with a lower incidence of adverse events in patients with newly diagnosed atrial fibrillation: a nationwide cohort study

European Heart Journal ◽

10.1093/eurheartj/ehab724.0336 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

S R Lee ◽

E K Choi ◽

K D Han ◽

S Oh ◽

G Y H Lip

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Ischemic Stroke ◽

Adverse Events ◽

Healthy Lifestyle ◽

Health Screening ◽

Major Adverse Cardiovascular Events ◽

Lifestyle Behaviors ◽

Newly Diagnosed ◽

Healthy Lifestyle Behaviors

Abstract Background Although unhealthy or healthy lifestyle behaviors tend to be clustered, studies on the risk of clinical outcomes depending on how the lifestyle behaviors are managed after atrial fibrillation (AF) diagnosis remain limited. Purpose We aimed to evaluate the association between a cluster of healthy lifestyle behaviors and the risk of adverse outcomes in patients with AF. Methods Using the Korean National Insurance Service database, patients who were newly diagnosed as nonvalvular AF between 2009 and 2016 and received national health screening examination within 2-year after AF diagnosis were included. A healthy lifestyle behavior score (HLS) was calculated by assigning 1 point each for “non-current” smoking, for non-drinking, and for performing regular exercise from the self-reported questionnaire in health screening examinations. The primary outcome was defined as major adverse cardiovascular events (MACE), including ischemic stroke, myocardial infarction, and hospitalization for heart failure. The secondary outcomes included individual components of the primary composite outcome and all-cause death. Results A total of 208,662 patients were included and 7.1%, 22.7%, 58.6%, and 11.6% were HLS 0, 1, 2, and 3 group, respectively. After multivariable adjustment, patients with HLS 1, 2, and 3 were associated with lower risks of MACE compared to those with HLS 0 (adjusted hazard ratio [95% confidence interval]: 0.788 [0.762–0.855], 0.654 [0.604–0.708], and 0.579 [0.527–0.636], respectively) (Figure). Increased number of healthy lifestyle behaviors were associated with lower risks of ischemic stroke, hospitalization for heart failure, and all-cause death. The risk reduction of healthy lifestyle combinations was consistently observed in various subgroups, regardless of CHA2DS2-VASc score and oral anticoagulant use. Conclusion Increased number of healthy lifestyle behaviors were significantly associated with lower MACE and all-cause death risks in patients with new-onset AF. These findings support the promotion of a healthy lifestyle to reduce the risk of adverse events in AF patients. FUNDunding Acknowledgement Type of funding sources: None.

Download Full-text

Abstract 17207: Cardiovascular Risks in Acute Leukemia Patients Treated With Anthracyclines

Circulation ◽

10.1161/circ.138.suppl_1.17207 ◽

2018 ◽

Vol 138 (Suppl_1) ◽

Author(s):

Yu Kang ◽

Srinivas Denduluri ◽

Bruna M Assuncao ◽

Marielle Scherrer-Crosbie

Keyword(s):

Heart Failure ◽

Ischemic Stroke ◽

Acute Leukemia ◽

Lymphoblastic Leukemia ◽

Multivariable Analysis ◽

Previous History ◽

Major Adverse Cardiovascular Events ◽

Symptomatic Heart Failure ◽

Coronary Syndrome ◽

History Of

Introduction: The incidence of acute leukemia has been increasing by about 1.6% per year in the last decade. Anthracyclines remain a standard of care for patients with acute leukemia; survival is increasing at about 1.0% per year. However, little is known about the incidence and risk of major adverse cardiovascular events (MACE) in patients with acute leukemia. Hypothesis: To investigate the incidence of MACE and the risk factors for MACE in patients with acute leukemia treated with anthracyclines. Methods: All adult patients with acute leukemia treated with anthracyclines between January 2005 and April 2018 at the hospital of University of Pennsylvania were studied. MACE were defined as cardiovascular death, symptomatic heart failure, non-fatal acute coronary syndrome, non-fatal ventricular arrhythmia and non-fatal ischemic stroke. Differences between patients with or without MACE were compared by Student’s t test or the Wilcoxon rank comparison. Cox proportional hazard analysis was used to determine significant clinical and echocardiographic parameters associated with MACE. Results: Six hundred and seventy-four patients (234 acute lymphoblastic leukemia (ALL), 440 acute myeloid leukemia (AML), age range: 22 to 93 years) were studied. Seventy-one patients (10.5%) experienced MACEs during a median follow-up period of 16 months (4 to 146 months) after the initiation of chemotherapy. The median time to MACE was 13 months (5 to 107 months). In the patients with MACE,59 (8.8%) developed symptomatic heart failure, 7 (1.0%) died of cardiovascular causes, 3 (0.4%) experienced non-fatal acute myocardial syndrome and 2 (0.3%) had an ischemic stroke. The Table summarizes the characteristics of patients with and without MACE. In a multivariable analysis, a previous history of heart failure (HR: 4.632, P=0.000, 95% CI: 2.572-8.341), leukemia type (HR: 3.155, P=0.002, 95% CI: 1.544-6.446) and baseline LVEF (HR: 0.973, P=0.000, 95% CI: 0.955-0.991) remained associated with MACE. Conclusion: Patients with acute leukemia treated with anthracyclines have a high rate of MACE after chemotherapy. A previous history of heart failure, baseline LVEF and type of leukemia may help to stratify acute leukemia patients at highest risk for MACEs after anthracycline therapy.

Download Full-text

Abstract 15090: Direct Oral Anticoagulation vs Vitamin K Antagonist in Atrial Fibrillation With Liver Disease: A Systematic Review and Meta-analysis

Circulation ◽

10.1161/circ.142.suppl_3.15090 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Mahmoud El Iskandarani ◽

Islam Shatla ◽

Muhammad Khalid ◽

Bara El Kurdi ◽

Timir Paul ◽

...

Keyword(s):

Atrial Fibrillation ◽

Systematic Review ◽

Ischemic Stroke ◽

Liver Disease ◽

Vitamin K ◽

Major Bleeding ◽

Lower Risk ◽

Meta Analysis ◽

Vitamin K Antagonist ◽

All Cause Mortality

Background: Current guidelines recommend against the use of direct oral anticoagulation (DOAC) therapy in patients with atrial fibrillation (AF) in the setting of significant liver disease (LD) due to lack of evidence in safety and efficacy studies. However, recently studies have investigated the role of DOAC in comparison to Vitamin K antagonist (VKA) in this category of patients. Therefore, we conducted a systematic review and meta-analysis to evaluate the efficacy and safety of this approach. Hypothesis: DOAC is safe and effective compared to VKA in AF with LD patients. Method: Unrestricted search of the PubMed, EMBASE, and Cochrane databases performed from inception until June 1, 2020 for studies comparing DOAC with VKA including more than 100 AF patients with LD. Relevant data were extracted and analyzed using Revman 5.3 software. Hazard ratio (HR) and 95% Confidence interval (CI) were calculated using the random-effects model. Result: A total of 5 studies (3 retrospective and 2 post hoc analysis) were included examining 39,064 patients with AF and LD (25,398 DOAC vs 13,669 VKA). DOAC is associated with lower risk of major bleeding compared to VKA with a HR of 0.68 (95% CI 0.47-0.98; I 2 =53%), all-cause mortality (HR 0.74;95% CI 0.59-0.94; I 2 =61%), and intracranial bleeding (HR 0.48; 95% CI 0.40-0.58; I 2 =0). There was no significant difference in ischemic stroke risk (HR 0.73; 95% CI 0.47-1.14; I 2 =72%) and gastrointestinal bleeding risk (0.96; 95% CI 0.61-1.51; I 2 =41%) between DOAC and VKA. Conclusion: DOAC is non-inferior to VKA regarding ischemic stroke prevention in AF patients with LD. Moreover, DOAC is associated with a lower risk of major bleeding, intracranial bleeding and all-cause mortality. Further randomized trials are needed to validate our findings.

Download Full-text

P1869A novel risk score to predict mortality in patients with atrial fibrillation: the BLACCK (AF) death risk score

European Heart Journal ◽

10.1093/eurheartj/ehz748.0619 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

A Samaras ◽

A Kartas ◽

G Fotos ◽

D Vasdeki ◽

G Dividis ◽

...

Keyword(s):

Atrial Fibrillation ◽

Risk Score ◽

Troponin T ◽

Cox Model ◽

Cardiac Biomarkers ◽

Accurate Estimation ◽

Discriminative Ability ◽

Death Risk ◽

Risk Of Death ◽

All Cause Mortality

Abstract Background Prior risk stratification schemes for atrial fibrillation (AF) have extensively focused on stroke as the principal outcome. However, an accurate estimation of the risk of death in patients with AF has received disproportional attention. Purpose The aim of this study was to develop and validate a risk score for predicting mortality in patients with AF who underwent a hospitalization for cardiac reasons. Methods The new risk score was developed and internally validated in 887 patients with AF, who were followed up for a median of 2 years. The outcome measure was all-cause mortality. Biomarker samples, echocardiographic data and renal function values were obtained at the date closest to hospital discharge. A Cox-model that determined the variables that significantly contributed to the prediction of all-cause mortality, was adapted to a risk points system through weighting of the model coefficients. The model was internally validated by bootstrapping, assessing both discrimination and calibration. Results 311 all-cause deaths were reported during 1755 person-years of follow-up (incidence rate 17.7 events per 100 person-years). The most important predictors of death were N-terminal pro B-type natriuretic peptide (NT-proBNP), high-sensitivity troponin-T (hs-TnT), left atrial area indexed to body surface area (LAAi), prior cardiac arrest, kidney impairment, congestive heart failure and age, and were included in the BLACCK (AF) death risk score. The score was well-calibrated (observed probabilities adjusted to predicted probabilities) and showed good discriminative ability [c-index 0.87 (95% CI 0.85–0.90)]. The internal validation of the score reported minimal over-fitting (optimism-corrected c-index of 0.85). The 1, 2 and 3-year risk of death derived by the score's total points may be calculated immediately through the nomogram (Figure 1). BLACCK (AF) risk score nomogram Conclusions We developed a simple, well-calibrated and internally validated novel risk score for predicting 1, 2 and 3-year risk of death in patients with AF after a hospitalization for cardiac reasons. The BLACCK (AF) death risk score included both cardiac biomarkers and clinical information, performed well and may assist physicians in decision-making when treating patients with AF.

Download Full-text

D-dimer and the incidence of heart failure and mortality after acute myocardial infarction

Heart ◽

10.1136/heartjnl-2020-316880 ◽

2020 ◽

pp. heartjnl-2020-316880 ◽

Cited By ~ 1

Author(s):

Xiaoyuan Zhang ◽

Shanjie Wang ◽

Jinxin Liu ◽

Yini Wang ◽

Hengxuan Cai ◽

...

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Acute Myocardial Infarction ◽

Plaque Rupture ◽

Risk Of Death ◽

Increased Risk ◽

Clinical Covariates ◽

All Cause Mortality ◽

D Dimer

ObjectiveD-dimer might serve as a marker of thrombogenesis and a hypercoagulable state following plaque rupture. Few studies explore the association between baseline D-dimer levels and the incidence of heart failure (HF), all-cause mortality in an acute myocardial infarction (AMI) population. We aimed to explore this association.MethodsWe enrolled 4504 consecutive patients with AMI with complete data in a prospective cohort study and explored the association of plasma D-dimer levels on admission and the incidence of HF, all-cause mortality.ResultsOver a median follow-up of 1 year, 1112 (24.7%) patients developed in-hospital HF, 542 (16.7%) patients developed HF after hospitalisation and 233 (7.1%) patients died. After full adjustments for other relevant clinical covariates, patients with D-dimer values in quartile 3 (Q3) had 1.51 times (95% CI 1.12 to 2.04) and in Q4 had 1.49 times (95% CI 1.09 to 2.04) as high as the risk of HF after hospitalisation compared with patients in Q1. Patients with D-dimer values in Q4 had more than a twofold (HR 2.34; 95% CI 1.33 to 4.13) increased risk of death compared with patients in Q1 (p<0.001). But there was no association between D-dimer levels and in-hospital HF in the adjusted models.ConclusionsD-dimer was found to be associated with the incidence of HF after hospitalisation and all-cause mortality in patients with AMI.

Download Full-text

486Are the results of the CASTLE-AF trial reproducible in the real life? Clinical outcomes after catheter ablation for atrial fibrillation with heart failure in a nationwide cohort study

European Heart Journal ◽

10.1093/eurheartj/ehz747.0135 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

A Bisson ◽

F Mondout ◽

J Herbert ◽

N Clementy ◽

B Pierre ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Cohort Study ◽

Catheter Ablation ◽

Lower Risk ◽

Multivariable Analysis ◽

Af Ablation ◽

Risk Of Death ◽

Systèmes D’Information ◽

Event Rates

Abstract Background Catheter ablation for atrial fibrillation (AF) is a validated therapy for patients with symptomatic AF to prevent recurrences. The CASTLE AF trial indicated that ablation for AF in patients with heart failure (HF) was associated with a lower rate of death from any cause or hospitalization for worsening HF than was medical therapy. The purpose of our study was to compare the incidence of these events in AF patients with HF after AF catheter ablation versus those not treated with AF ablation at a nationwide level in centers possibly less well experienced. Methods This French longitudinal cohort study was based on the national hospitalization PMSI (Programme de Médicalisation des Systèmes d'Information) database covering hospital care from the entire population. We included all patients, over 18 years old, with AF and HF from January 2010 to December 2015. Crude event rates were ascertained and hazard ratios (HR) were estimated using Cox proportional hazards risk model. Propensity-matched Cox regression was also used to compare event rates according to AF ablation usage status. Results Among the 261,449 patients identified with AF and HF, 1,270 patients were treated with AF ablation (24% female, mean age 63±10 yo) and 260,179 did not have AF ablation (45% female, mean age 79±11 yo). During follow-up (417±502 days), there were 56,981 hospitalizations with a primary diagnosis of HF and 81,393 deaths were recorded. Incidence of hospitalization for HF was significantly lower in patients with AF ablation than in those with no ablation (13.74% vs 51.11% person per year respectively, p<0.0001). Incidence of death was also significantly lower in patients with AF ablation than in those with no ablation (6.07% vs 27.42% person per year respectively, p<0.0001). These associations were confirmed in a multivariable analysis after adjustment on age and other comorbidities (HR 0.33, 95% CI 0.28–0.39, p<0.0001 for HF and HR 0.38, 95% CI 0.31–0.48, p<0.0001 for all-cause death). After 1:1 propensity score matching, AF ablation was also associated with a lower risk of hospitalization for HF (HR 0.38, 95% CI 0.31–0.47, p<0.0001) and a lower risk of death (HR 0.54, 95% CI 0.42–0.70, p<0.0001). Conclusion In the nationwide analysis of unselected AF patients with HF seen in hospitals, AF ablation was independently associated with a lower risk of hospitalization for HF and death. This provides “real world” data consistent with those observed in recent trials with lower numbers of highly selected patients

Download Full-text