Ivabradine in Heart Failure Patients With Reduced Ejection Fraction and History of Paroxysmal Atrial Fibrillation From Multi-Center Experiences

Abstract Background The presence of atrial fibrillation (AF) has been demonstrated to be associated with poor clinical outcomes in heart failure patients with reduced ejection fraction. Objective This study aimed to elucidate the impact of the presence of atrial fibrillation (AF) on the clinical characteristics, therapeutics, and outcomes in patients with heart failure and preserved ejection fraction (HFpEF). Methods PURSUIT-HFpEF is a multicenter prospective observational study including patients hospitalized for acute heart failure with left ventricular ejection fraction of >50%. Patients with acute coronary syndrome or severe valvular disease were excluded. Results Of 486 HFpEF patients (age, 80.8±9.0 years old; male, 47%) from 24 cardiovascular centers, 199 (41%) had AF on admission. Patients with AF had lower systolic blood pressures (142±27 vs. 155±35mmHg, p<0.0001) and higher heart rates (91±29 vs. 82±26bpm, p<0.0001) than those without. There was no difference in the usage of inotropes or mechanical ventilation between the 2 groups. A higher quality of life score (EQ5D, 0.72±0.27 vs. 0.63±0.30, p=0.002) was observed at discharge in patients with than without AF. In addition, AF patients tended to demonstrate lower in-hospital mortality rates (0.5% vs. 2.4%, p=0.09) and shorter hospital stays (20.3±12.1 vs. 22.6±18.4 days, p=0.09) than those without. During a mean follow up of 360±111 days, mortality (14.1% vs. 15.3) and heart failure re-hospitalization rates (13.1% vs. 13.9%) were comparable between the 2 groups. Conclusion In contrast to heart failure patients with reduced ejection fraction, AF on admission was not associated with poor long-term clinical outcomes among HFpEF patients. Several in-hospital outcomes were better in patients with AF than in those without. Acknowledgement/Funding None

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Cardiac contractility modulation: first experience in heart failure patients with reduced ejection fraction and permanent atrial fibrillation

EP Europace ◽

10.1093/europace/euu050 ◽

2014 ◽

Vol 16 (8) ◽

pp. 1205-1209 ◽

Cited By ~ 15

Author(s):

S. Roger ◽

R. Schneider ◽

B. Rudic ◽

V. Liebe ◽

K. Stach ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Ejection Fraction ◽

Cardiac Contractility ◽

Cardiac Contractility Modulation ◽

Reduced Ejection Fraction ◽

Heart Failure Patients ◽

Permanent Atrial Fibrillation

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New-onset Atrial Fibrillation: An Independent Predictor of in-hospital Mortality in Reduced Ejection Fraction Heart Failure Patients

Journal of Ankara University Faculty of Medicine ◽

10.4274/atfm.galenos.2020.39200 ◽

2020 ◽

Vol 73 (2) ◽

pp. 102-106

Author(s):

Nil Özyüncü ◽

Sadi Güleç

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Ejection Fraction ◽

Hospital Mortality ◽

Independent Predictor ◽

Reduced Ejection Fraction ◽

Heart Failure Patients ◽

Onset Atrial Fibrillation ◽

New Onset

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Abstract 16235: The Impact of Atrial Fibrillation on Heart Failure With Preserved versus Reduced Ejection Fraction in the Middle East Region: Insights From the Gulf aCute heArt failuRe rEgistry (Gulf CARE)

Circulation ◽

10.1161/circ.130.suppl_2.16235 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Nidal A Asaad ◽

Kadhim Sulaiman ◽

Mohammed K Mohsen ◽

Jassim Al-Suwaidi ◽

Alawi Alsheikh-Ali ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Ejection Fraction ◽

Middle Eastern ◽

Covariate Adjustment ◽

Reduced Ejection Fraction ◽

Gulf Countries ◽

Number Of Patients ◽

History Of ◽

The Impact

Background: Atrial Fibrillation (AF) and heart failure (HF) are two common prevalent conditions that may present independent of each other or coexist. The impact of AF on mortality in patients with HF and reduced (HFrEF) or preserved ejection fraction (HFpEF) is unclear with conflicting results. Methods: We analyzed data from the Gulf acute HF registry, a prospective, multinational registry of patients admitted with acute HF in 47 hospitals in 7 Middle Eastern Arab Gulf countries (recruited between February 13, 2012 and November 13, 2012). We compared the 12-month mortality in patients with AF versus sinus rhythm (SR) in both types of HF (HFrEF and HFpEF). Results: Among 5005 patients admitted with HF, 835 patients (16.7%) had AF and 3964 (79.2 %) had no history of AF and were in SR. Remaining percentage included patients with rhythms other than AF or SR (e.g. junctional rhythm). After excluding patients with no available echocardiography and those with other rhythms, the number of patients in our study population was 4394 patients where 770 patients (17.5 %) were in the AF group ( 10.2% with HFrEF and 7.3% with HFpEF) and 3624 patients (82.5 %) were in the SR group (56.2% with HFrEF and 26.3% with HFpEF). The mortality at 12 month was significantly higher in the AF compared to SR group (21.1% vs. 16.3%; P = 0.001), even after covariate adjustment (odds ratio [OR] = 1.23, 95% C.I 1.01-1.5; P = 0.04). Furthermore, subgroup analysis revealed that AF was associated with a higher risk of 12 month mortality in patients with HFrEF (23.7% vs. 16.6%; P = 0.001) but not among patients with HFpEF (17.5% vs. 15.8%; P = 0.48), even after covariate adjustment (adjusted OR among patients with HFrEF = 1.40, 95% C.I. 1.10-1.80; P=0.009 while adjusted OR among patients with HFpEF = 0.93. 95% C.I.:0.65 - 1.32; P=0.67). Conclusion: AF is associated with significantly higher 12-month mortality among patients with HFrEF, but not among those with HFpEF, suggesting a stronger impact of AF in patients with systolic HF.

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