Abstract 15198: Predictors of Adverse Cardiovascular Outcomes in Patients With Atrial Fibrillation and Heart Failure With Preserved Systolic Function: A Topcat Americas Post Hoc Analysis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Sanjeev Saksena ◽  
April Slee ◽  
Dhanunjaya Lakkireddy ◽  
Dipen Shah ◽  
Luigi Di Biase ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Proportional Hazards ◽  
Systolic Function ◽  
Cox Proportional Hazards ◽  
Study Entry ◽  
Pump Failure ◽  
Death Time ◽  
Arrhythmogenic Substrate

Introduction: Presence of atrial fibrillation (AF) is known to increase mortality and impact cardiovascular(CV) outcomes in heart failure (HF) patients (pts) with preserved systolic function (pEF) but its causes are unknown Hypothesis: We hypothesized that AF presentation & clinical factors impact mode of death & CV outcomes of HFpEF pts in the TOPCAT AMERICAS trial. Methods: We analyzed demographic, clinical, ECG and AF presentation as predictors of CV mortality, sudden death( SCD) and pump failure death(PFD). We examined two AF presentations 1. Pts in sinus rhythm (SR, n=1319) compared to pts in AF (n=446) on ECG at study entry or 2. Pts with no AF event by history or ECG ( n=1007 ) compared to those with any AF event (n=760 ) during a mean follow up period of 2.9 years(yrs). Results: AF pts when compared to the rest of the study population were more likely to be older, male, Caucasian origin, have more alcohol use, diabetes, percutaneous coronary interventions. 5 yr CV mortality was higher in pts with AF on ECG (30%) than those in sinus rhythm (18%, p=0.014) but 5 yr SCD was lower (10% in AF on ECG & 7% in any AF) & comparable to SR (7% & 9% respectively, p=ns). 5 yr PFD was higher (13%) than SR (5%, p=0.007. )Table shows Cox proportional hazards analysis of covariates associated with time to CV death, time to SCD & time to PFD adjusted for baseline imbalances. Conclusions:: 1. CV death risk in HFpEF pts increased with age, in minorities, smokers, diabetics, with lower systolic bp, elevated heart rate & AF on ECG.. 2. SCD was more frequent in males, African Americans & diabetics but was low in both AF & SR, perhaps due to a dominant atrial & limited ventricular arrhythmogenic substrate in HFpEF. 3. PFD in HFpEF increased with age, ECG recorded AF & elevated heart rate.This may reflect importance of atrioventricular synchrony in HFpEF. 4. The recording of AF on ECG at study entry was more strongly associated with CV death & PFD, possibly due to greater AF burden in this group compared to those with any AF even..

P6355The behavior of atrial fibrillation in patients with heart failure hospitalization

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Fukunaga ◽  
K Hirose ◽  
A Isotani ◽  
T Morinaga ◽  
K Ando
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Cardiovascular Disease ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Significant Difference ◽  
The Impact

Abstract Background Relationship between atrial fibrillation (AF) and heart failure (HF) is often compared with proverbial question of which came first, the chicken or the egg. Some patients showing AF at the HF admission result in restoration of sinus rhythm (SR) at discharge. It is not well elucidated that the restoration into SR during hospitalization can render the preventive effect for rehospitalization. Purpose To investigate the impact of restoration into SR during hospitalization for readmission rate of the HF patients showing AF. Methods We enrolled consecutive 640 HF patients hospitalized from January 2015 to December 2015. Patients data were retrospectively investigated from medical record. Patients showing atrial fibrillation on admission but unrecognized ever were defined as “incident AF”; patients with AF diagnosed before admission were defined as “prevalent AF”. Primary endpoint was a composite of death from cardiovascular disease or hospitalization for worsening heart failure. Secondary endpoints were death from cardiovascular disease, unplanned hospitalization related to heart failure, and any hospitalization. Results During mean follow up of 19 months, 139 patients (22%) were categorized as incident AF and 145 patients (23%) were categorized as prevalent AF. Among 239 patients showing AF on admission, 44 patients were discharged in SR (39 patients in incident AF and 5 patients in prevalent AF). Among incident AF patients, the primary composite end point occurred in significantly fewer in those who discharged in SR (19% vs. 42% at 1-year; 23% vs. 53% at 2-year follow-up, p=0.005). To compare the risk factors related to readmission due to HF with the cox proportional-hazards model, AF only during hospitalization [Hazard Ratio (HR)=0.37, p<0.01] and prevalent AF (HR=1.67, p=0.04) was significantly associated. There was no significant difference depending on LVEF. Conclusion Newly diagnosed AF with restoration to SR during hospitalization was a good marker to forecast future prognosis.

scholarly journals The association of digoxin with mortality in ischemic heart failure: a secondary analysis of the STICH trial

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
L Pandya ◽  
D.L Brown
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Medical Therapy ◽  
Proportional Hazards ◽  
Cardiovascular Death ◽  
Cox Proportional Hazards ◽  
Ischemic Heart ◽  
Ischemic Heart Failure ◽  
Increased Risk ◽  
All Cause Mortality

Abstract Background Digoxin, one of the first treatments for symptoms of congestive heart failure (CHF), is currently used in the management of persistent CHF symptoms as well as for ventricular rate control in atrial fibrillation. Current guidelines suggest digoxin as an adjunct to optimal medical therapy for symptomatic improvement in CHF. However, the data regarding the effect of digoxin use on mortality continue to be conflicting. Purpose The aim of this retrospective study was to evaluate the association of digoxin therapy with mortality in patients with ischemic heart failure defined by severe left ventricular (LV) dysfunction and coronary artery disease (CAD) in the Surgical Treatment for Ischemic Heart Failure (STICH) trial. Methods STICH randomized 1012 patients with CAD and LV ejection fraction&lt;35% to coronary artery bypass graft (CABG) surgery and medical therapy vs. medical therapy alone. Factors predictive of digoxin use were identified with a binomial logistic regression model. Multivariable Cox proportional hazards modelling was performed with digoxin use modelled as a segmented time-dependent covariate. The model was adjusted for baseline clinical characteristics (including age, race, hypertension, hyperlipidemia, diabetes mellitus, peripheral vascular disease, NYHA heart failure class, previous myocardial infarction, atrial fibrillation, creatinine level, smoking status, and STICH treatment group) and stratified based on sex. All covariates were verified to meet the proportional hazards assumption. The primary outcome was all-cause mortality. Secondary outcomes included death and hospitalization due to cardiovascular causes. Relative risks were expressed as adjusted hazard ratios (aHR) with 95% confidence intervals (CI). Results Of the 1012 patients, 351 (35% [36% of male patients and 27% of female patients]) reported digoxin use for some duration during the study period. Significant predictors of digoxin use included minority status, NYHA class, previous myocardial infarction, and baseline diagnosis of hypertension, diabetes, or atrial fibrillation. At a mean follow-up of 9.8 years, 566 patients (55.7%) experienced all-cause mortality and 387 patients (38.1%) died due to cardiovascular causes. The adjusted Cox proportional hazards model demonstrated that digoxin use was independently associated with an increased risk of all-cause mortality (aHR 1.22, 95% CI: 1.00–1.49, P=0.049). Digoxin use was also associated with increased risk of cardiovascular death (aHR 1.29, 95% CI: 1.02–1.64, P=0.032). There was no impact of digoxin on hospitalization for cardiovascular causes. Conclusion Use of digoxin in patients with ischemic heart failure was associated with an increased risk of both all-cause and cardiovascular death. Funding Acknowledgement Type of funding source: None

scholarly journals Performance of Atrial Fibrillation Risk Prediction Models in Over Four Million Individuals

2020 ◽  
Author(s):  
Shaan Khurshid ◽  
Uri Kartoun ◽  
Jeffrey M. Ashburner ◽  
Ludovic Trinquart ◽  
Anthony Philippakis ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Risk Prediction ◽  
Proportional Hazards ◽  
Prediction Models ◽  
Predictive Accuracy ◽  
Health Management ◽  
Cox Proportional Hazards ◽  
Risk Scores ◽  
Office Visits

Background - Atrial fibrillation (AF) is associated with increased risks of stroke and heart failure. Electronic health record (EHR) based AF risk prediction may facilitate efficient deployment of interventions to diagnose or prevent AF altogether. Methods - We externally validated an EHR atrial fibrillation (EHR-AF) score in IBM Explorys Life Sciences, a multi-institutional dataset containing statistically de-identified EHR data for over 21 million individuals ("Explorys Dataset"). We included individuals with complete AF risk data, ≥2 office visits within two years, and no prevalent AF. We compared EHR-AF to existing scores including CHARGE-AF, C 2 HEST, and CHA 2 DS 2 -VASc. We assessed association between AF risk scores and 5-year incident AF, stroke, and heart failure using Cox proportional hazards modeling, 5-year AF discrimination using c-indices, and calibration of predicted AF risk to observed AF incidence. Results - Of 21,825,853 individuals in the Explorys Dataset, 4,508,180 comprised the analysis (age 62.5, 56.3% female). AF risk scores were strongly associated with 5-year incident AF (hazard ratio [HR] per standard deviation [SD] increase 1.85 using CHA 2 DS 2 -VASc to 2.88 using EHR-AF), stroke (1.61 using C 2 HEST to 1.92 using CHARGE-AF), and heart failure (1.91 using CHA 2 DS 2 -VASc to 2.58 using EHR-AF). EHR-AF (c-index 0.808 [95%CI 0.807-0.809]) demonstrated favorable AF discrimination compared to CHARGE-AF (0.806 [0.805-0.807]), C 2 HEST (0.683 [0.682-0.684]), and CHA 2 DS 2 -VASc (0.720 [0.719-0.722]). Of the scores, EHR-AF demonstrated the best calibration to incident AF (calibration slope 1.002 [0.997-1.007]). In subgroup analyses, AF discrimination using EHR-AF was lower in individuals with stroke (c-index 0.696 [0.692-0.700]) and heart failure (0.621 [0.617-0.625]). Conclusions - EHR-AF demonstrates predictive accuracy for incident AF using readily ascertained EHR data. AF risk is associated with incident stroke and heart failure. Use of such risk scores may facilitate decision-support and population health management efforts focused on minimizing AF-related morbidity.

scholarly journals Biomarkers of Inflammation and Risk of Hospitalization for Heart Failure in Patients With Atrial Fibrillation

2021 ◽  
Author(s):  
Alexander P. Benz ◽  
Stefanie Aeschbacher ◽  
Philipp Krisai ◽  
Giorgio Moschovitis ◽  
Steffen Blum ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Interleukin 6 ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Unique Identifier ◽  
Contemporary Sample ◽  
Increased Risk ◽  
Hs Crp ◽  
Inflammation Score

Background Hospitalization for heart failure (HF) is very common in patients with atrial fibrillation (AF). We hypothesized that biomarkers of inflammation can identify patients with AF at increased risk of this important complication. Methods and Results Patients with established AF were prospectively enrolled. Levels of hs‐CRP (high‐sensitivity C‐reactive protein) and interleukin‐6 were measured from plasma samples obtained at baseline. We calculated an inflammation score ranging from 0 to 4 (1 point for each biomarker between the 50th and 75th percentile, 2 points for each biomarker above the 75th percentile). Individual associations of biomarkers and the inflammation score with HF hospitalization were obtained from multivariable Cox proportional hazards models. A total of 3784 patients with AF (median age 72 years, 24% prior HF) were followed for a median of 4.0 years. The median (interquartile range) plasma levels of hs‐CRP and interleukin‐6 were 1.64 (0.81–3.69) mg/L and 3.42 (2.14–5.60) pg/mL, respectively. The overall incidence of HF hospitalization was 3.04 per 100 person‐years and increased from 1.34 to 7.31 per 100 person‐years across inflammation score categories. After multivariable adjustment, both biomarkers were significantly associated with the risk of HF hospitalization (per increase in 1 SD, adjusted hazard ratio [HR], 1.22; 95% CI, 1.11–1.34 for log‐transformed hs‐CRP; adjusted HR, 1.48; 95% CI, 1.35–1.62 for log‐transformed interleukin‐6). Similar results were obtained for the inflammation score (highest versus lowest score, adjusted HR, 2.43; 95% CI, 1.80–3.30; P value for trend <0.001). Conclusions Biomarkers of inflammation strongly predicted HF hospitalization in a large, contemporary sample of patients with AF. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02105844.

scholarly journals Natriuretic peptides predict future heart failure and cardiovascular death in an unselected population of patients presenting to hospital: interactions with atrial fibrillation

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
P Brady ◽  
W Chua ◽  
F Nehaj ◽  
D Connolly ◽  
A Khashaba ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Natriuretic Peptides ◽  
Proportional Hazards ◽  
Cardiovascular Death ◽  
Cox Proportional Hazards ◽  
Sensitivity Analyses ◽  
P Value ◽  
Composite Outcome ◽  
C Statistic

Abstract Aims Natriuretic peptides are routinely quantified to diagnose heart failure (HF). Their concentrations are also elevated in atrial fibrillation (AF). To clarify their interpretation, we measured natriuretic peptides in unselected patients with cardiovascular conditions and related their concentrations to AF and HF status and to outcomes. Methods and results Consecutive patients with cardiovascular conditions presenting to a large teaching hospital (median age 70 [IQR 60–78] years, 40% women) underwent clinical assessment, 7-day ECG-monitoring, and echocardiography to diagnose AF and HF. N-terminal pro B-type natriuretic peptide (NT-proBNP) was centrally quantified. Clinical characteristics and NT-proBNP concentrations were related to HF hospitalization or cardiovascular death. Follow-up data was available in 1611/1616 patients (99.7%) and analysis performed at 2.5 years. Based on a literature review, four NT-proBNP groups were defined (&lt;300pg/ml, 300–999pg/ml, 1000–1999pg/ml and ≥2000pg/ml). Multivariate Cox proportional hazards analysis of the composite outcome against AF and HF phenotype groups. This was adjusted for confounding factors including age, sex, race, body mass index, hypertension, diabetes, coronary artery disease, severe valvular heart disease, left bundle branch block, hyponatraemia, urea, haemoglobin, estimated glomerular filtration rate, NT-proBNP, medical treatment with ACE inhibitors or angiotensin receptor blockers, beta-blockers, diuretic (thiazide or loop diuretics), and anticoagulants (novel oral anticoagulant or vitamin K antagonist). Cox proportional hazards analysis adjusted for confounding variables for the composite outcome against baseline NT-proBNP concentration ranges was also performed in each patient group based on AF and HF status. HF hospitalization or cardiovascular death increased from patients with neither AF nor HF (36/488, 3.2/100 person-years), to 55/353 (7.1/100 person-years) in patients with AF only, 91/366 (12.1/100 person-years) in patients with HF only, and, 128/404 (17.7/100 person-years) in patients with AF plus HF (p&lt;0.001). Higher NT-proBNP concentrations predicted the outcome in patients with AF only (C-statistic 0.82 [95% CI 0.77 to 0.86], p-value&lt;0.001) and in other phenotype groups (C statistic in AF plus HF 0.66 [95% CI 0.61 to 0.70], p-value&lt;0.001)). Sensitivity analyses confirmed these findings. Conclusion Elevated NT-proBNP concentrations predict future HF events in patients with AF irrespective of the presence of HF. In line with previous studies in HF, an NT-proBNP threshold of 1000 pg/ml is useful to identify high-risk patients with AF whether or not they are diagnosed with HF at the time of assessment. Pending external validation, these findings encourage the routine quantification of NT-proBNP in the initial assessment of patients with AF. FUNDunding Acknowledgement Type of funding sources: Public grant(s) – EU funding. Main funding source(s): 1) This study was partially supported by European Union BigData@Heart and 2) CATCH ME (Characterising Afib by Translating its Causes into Health Modifiers in the Elderly)

Abstract P009: Risk of Mortality According to Burden of Atrial Fibrillation: Results From a 60-year Cohort Study

Circulation ◽  
2016 ◽  
Vol 133 (suppl_1) ◽  
Author(s):  
William F McIntyre ◽  
Mahmoud Tourabi ◽  
Philip D St John ◽  
Robert B Tate
Keyword(s):  
Atrial Fibrillation ◽  
Adverse Events ◽  
Sinus Rhythm ◽  
Proportional Hazards ◽  
Anticoagulation Therapy ◽  
Cox Proportional Hazards ◽  
Risk Of Death ◽  
Increased Risk ◽  
All Cause Mortality

Introduction: Atrial Fibrillation (AF) is the most common serious cardiac arrhythmia and is associated with an increased risk of stroke and mortality. These risks can be modified with oral anticoagulation therapy. Clinically, the arrhythmia can be permanent or intermittent. Prior studies that have used time-constant, categorical covariates to examine the relationship between the pattern of AF and the occurrence of adverse events have produced conflicting results. We hypothesized that the amount of time that patients spend in AF, hereinafter termed arrhythmia “burden”, may be important in predicting adverse events. Objective: To examine the effects of the burden of AF on all-cause mortality. Methods: The Manitoba Follow-Up Study is a longitudinal, prospective study of 3983 originally healthy young men (mean age at entry 30 years) who have been followed with routine medical and electrocardiographic examinations since 1948. After 60 years of follow-up to July 1, 2008, AF had been documented on the electrocardiograms of 581 men (15% of the cohort) and 3182 (80%) of the original cohort had died. We created a Cox proportional hazards model with time-dependent covariates to estimate relative risks for mortality according to AF burden. AF status during each follow-up visit was classified as persistent when the patient was in AF on consecutive examinations, transient when the patient reverted to sinus rhythm after being in AF and incident when the patient developed AF after a period in sinus rhythm. Results: Results of the Cox proportional hazards regression model are displayed in the Table. Age, persistent AF and incident AF were all significant variables in the model. Holding all the other variables constant, persistent AF increased the risk of death by two times and incident AF increased the risk of death by 87%. Conclusions: Persistent AF and incident AF are associated with increased all-cause mortality. Estimating AF burden may have implications for risk stratification in patients with AF.

scholarly journals Area Deprivation Index and Cardiac Readmissions: Evaluating Risk‐Prediction in an Electronic Health Record

2021 ◽  
Author(s):  
Amber E. Johnson ◽  
Jianhui Zhu ◽  
William Garrard ◽  
Floyd W. Thoma ◽  
Suresh Mulukutla ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Myocardial Ischemia ◽  
Proportional Hazards ◽  
Predictive Ability ◽  
Cox Proportional Hazards ◽  
Deprivation Index ◽  
Area Deprivation ◽  
Risk Reclassification ◽  
Increased Risk

Background Assessment of the social determinants of post‐hospital cardiac care is needed. We examined the association and predictive ability of neighborhood‐level determinants (area deprivation index, ADI), readmission risk, and mortality for heart failure, myocardial ischemia, and atrial fibrillation. Methods and Results Using a retrospective (January 1, 2011–December 31, 2018) analysis of a large healthcare system, we assess the predictive ability of ADI on 30‐day and 1‐year readmission and mortality following hospitalization. Cox proportional hazards models analyzed time‐to‐event. Log rank analyses determined survival. C‐statistic and net reclassification index determined the model’s discriminative power. Covariates included age, sex, race, comorbidity, number of medications, length of stay, and insurance. The cohort (n=27 694) had a median follow‐up of 46.5 months. There were 14 469 (52.2%) men and 25 219 White (91.1%) patients. Patients in the highest ADI quintile (versus lowest) were more likely to be admitted within 1 year of index heart failure admission (hazard ratio [HR], 1.25; 95% CI, 1.03‒1.51). Patients with myocardial ischemia in the highest ADI quintile were twice as likely to be readmitted at 1 year (HR, 2.04; 95% CI, 1.44‒2.91]). Patients with atrial fibrillation living in areas with highest ADI were less likely to be admitted within 1 year (HR, 0.79; 95% CI, 0.65‒0.95). As ADI increased, risk of readmission increased, and risk reclassification was improved with ADI in the models. Patients in the highest ADI quintile were 25% more likely to die within a year (HR, 1.25 1.08‒1.44). Conclusions Residence in socioeconomically disadvantaged communities predicts rehospitalization and mortality. Measuring neighborhood deprivation can identify individuals at risk following cardiac hospitalization.

scholarly journals Chronic kidney disease and risk of atrial fibrillation and heart failure in general population-based cohorts – the BiomarCaRE project

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M Rehm ◽  
D Rothenbacher ◽  
L Iacoviello ◽  
S Costanzo ◽  
H Tunstall-Pedoe ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
General Population ◽  
Proportional Hazards ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Adverse Outcomes ◽  
Cox Proportional Hazards Models

Abstract Background Chronic kidney disease (CKD) has a complicated relationship with the heart, leading to many adverse outcomes. Purpose The aim of the study was to evaluate the relationship between CKD and the incidence of atrial fibrillation (AF) and heart failure (HF) along with mortality as a competing risk in general population cohorts. Methods This study was conducted as part of the BiomarCaRE project using harmonised data from 12 population-based cohorts (n=40,212) from Europe. Cox proportional hazards models were used to determine hazard ratios (HRs) for the incidence of AF and HF in CKD and with competing mortality risk after adjusting for covariates. Results Mean age at baseline was 51.1 (standard deviation 11.9) years, and 49.3% were men. Overall, 3.5% had CKD at baseline. The rate for incident AF was 3.9 per 1000 person-years during follow-up. The HR for AF for those with CKD compared with those without was 1.23 (95% CI 1.00–1.52, p=0.0465) after adjustment for covariates. The rate for incident HF was 3.9 per 1000 person-years and the associated risk in the presence of CKD was HR 1.67 (95% CI 1.39–2.01). In subjects with CKD, N-terminal pro-B-type natriuretic peptide (NT-proBNP) showed an association with AF, while NT-proBNP and C-reactive protein (CRP) showed an association with HF. Conclusion CKD is an independent risk factor for subsequent AF and even more so for HF. In patients with CKD, NT-proBNP was clearly associated with subsequent risk of AF. In addition to this marker, hs-CRP was also associated with risk of subsequent HF. FUNDunding Acknowledgement Type of funding sources: Public grant(s) – EU funding. Main funding source(s): 7th framework programme collaborative project, grant agreement no. HEALTH-F2-2011_278913. Atrial Fibrillation and HF in CKD

Abstract 14867: Atrial Fibrillation is Associated With Risk of Incident Heart Failure and Its Subtypes

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Charles D Nicoli ◽  
Wesley T O'Neal ◽  
Emily B Levitan ◽  
Matthew J Singleton ◽  
Suzanne E Judd ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Risk Factor ◽  
Racial Differences ◽  
Proportional Hazards ◽  
Left Ventricular ◽  
Cox Proportional Hazards ◽  
Left Ventricular Ejection ◽  
Increased Risk

Background: Heart failure (HF) is an established risk factor for atrial fibrillation (AF). However, the extent to which AF is a risk factor for HF and its subtypes in a racially diverse population is unclear. Methods: This analysis included 25,787 participants free of baseline HF from the REasons for Geographic And Racial Differences in Stroke (REGARDS). AF at baseline was identified by electrocardiogram and self-reported physician diagnosis. HF events during follow-up were ascertained from medical records with subclassification by left ventricular ejection function (EF) at time of diagnosis as HF with reduced EF (HFrEF; EF<40%), HF with preserved EF (HFpEF; EF≥50%), mid-range HF (EF 40-49%) and unclassified. Cox proportional-hazards regression was used to separately examine the association of baseline AF and incident overall HF, HFpEF, and HFrEF. The Lunn-McNeil method was used to test differences in the association of AF by HFrEF & HFpEF. Consistency of the associations of AF with HF and its subtypes was examined in subgroups stratified by sex and race. Results: AF was detected in 1,924 (7.5%) participants at baseline (2003-2007). Over 10.1 years median follow-up, 1,109 HF events occurred (388 HFrEF, 356 HFpEF, 77 mid-range HF, and 288 unclassified). AF was associated with more than 2-fold increased risk of overall HF as well as its subtypes HFpEF and HFrEF in models adjusted for socio-demographics and cardiovascular risk factors. The strength of associations was slightly attenuated after adjustments for Warfarin, aspirin and statin. A stronger association of AF with HFrEF than HFpEF was observed, but the difference was not statistically significant. These associations were consistent among men, women, Black and White subgroups (Table). Conclusions: AF is strongly associated with both HFrEF and HFpEF. While further investigation of the underlying mechanisms is needed, our findings extend the sequelae of AF beyond stroke to include HF regardless of type.

Abstract 16430: Risk Factors Associated With Worsening Left Ventricular Function Post-bone Marrow Transplant in Multiple Myeloma Patients

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Jim Chen ◽  
Tanya Sharma ◽  
Fuad Habash ◽  
Emily Sanders ◽  
Abdullah Malkawi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Multiple Myeloma ◽  
Bone Marrow ◽  
Bone Marrow Transplant ◽  
Proportional Hazards ◽  
Systolic Function ◽  
Marrow Transplant ◽  
Left Ventricular ◽  
Cox Proportional Hazards ◽  
Lv Function

Background: New onset or worsening congestive heart failure (CHF) poses a significant challenge in multiple myeloma (MM) patients post bone marrow transplant (BMT). The aim of this study was to determine co-morbidies that increased the risk of worsening left ventricular (LV) function post-BMT. Methods: Retrospective study looking at MM patients between 2013 to 2019 with at least 1 bone marrow transplant. The primary end point was the time from BMT to >10% worsening ejection fraction (EF) noted on echocardiogram, compared to baseline values. A Cox proportional hazards regression model was used to create hazard ratios. Results: A total of 524 patients with diagnosis of MM were included who had at least 1 BMT with an average follow up time of 309.3 days. Prior hospitalizations of heart failure prior to BMT significantly increased the risk of developing reduced systolic function post transplant (HR 6.38 [95% CI 2.07 - 19.63]). Other contributing factors for reduced EF include: elevated BMI, history of hypertension, liver disease, peripheral vascular disease, stroke, and lenalidomide prior to BMT. Conclusion: This study was able to identify prognostic factors contributing to worsening heart failure.

Sign in / Sign up

Export Citation Format

Share Document