Heart failure subtypes and thromboembolic risk in patients with atrial fibrillation: The PREFER in AF - HF substudy

Siller‐Matula, Jolanta M.; Pecen, Ladislav; Patti, Giuseppe; Lucerna, Markus; Kirchhof, Paulus; Lesiak, Maciej; Huber, Kurt; Verheugt, Freek W.A.; Lang, Irene; Renda, Giulia; Schnabel, Renate B.; Wachter, Rolf; Kotecha, Dipak; Sellal, Jean‐Marc; Rohla, Miklós; Ricci, Fabrizio; Caterina, Raffaele De

doi:10.1016/j.ijcard.2018.04.093

Cited by 40 publications

(25 citation statements)

References 39 publications

(51 reference statements)

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“…Since there was a large portion of patients with unspecified HF, we are unable to draw meaningful conclusions about differences in HF type between cohorts. [42]. A FDA Mini-Sentinel evaluation, which aimed to describe the validity of algorithms used to detect HF using administrative and claims data sources, determined that current coding systems are unable to distinguish systolic/diastolic HF or detail a patient’s disease severity [43].…”

Section: Discussionmentioning

confidence: 99%

Effectiveness and safety of oral anticoagulants in older adults with non-valvular atrial fibrillation and heart failure

Amin

Reeves

et al. 2019

PLoS ONE

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Direct oral anticoagulants (DOACs) are at least as efficacious and safe as warfarin among non-valvular atrial fibrillation (NVAF) patients; limited evidence is available regarding NVAF patients with heart failure (HF). US Medicare enrollees with NVAF and HF initiating DOACs (apixaban, rivaroxaban, dabigatran) or warfarin were selected. Propensity score matching and Cox models were used to estimate the risk of stroke/systemic embolism (SE), major bleeding (MB), and major adverse cardiac events (MACE) comparing DOACs versus warfarin and DOACs versus DOACs. We identified 10,570 apixaban-warfarin, 4,297 dabigatran-warfarin, 15,712 rivaroxaban-warfarin, 4,263 apixaban-dabigatran, 10,477 apixaban-rivaroxaban, and 4,297 dabigatran-rivaroxaban matched pairs. Compared to warfarin, apixaban had lower rates of stroke/SE (hazard ratio = 0.64, 95% confidence interval = 0.48–0.85), MB (hazard ratio = 0.66, 0.58–0.76), and MACE (hazard ratio = 0.73,0.67–0.79); dabigatran and rivaroxaban had lower rates of MACE (hazard ratio = 0.87,0.77–0.99; hazard ratio = 0.84, 0.79–0.89, respectively). Rivaroxaban had a lower stroke/SE rate (hazard ratio = 0.65, 0.52–0.81) and higher MB rate (hazard ratio = 1.18, 1.08–1.30) versus warfarin. Compared to dabigatran and rivaroxaban, apixaban had lower MB (hazard ratio = 0.71, 0.57–0.89; hazard ratio = 0.55, 0.49–0.63) and MACE rates (hazard ratio = 0.80, 0.69–0.93; hazard ratio = 0.86, 0.79–0.94), respectively. All DOACs had lower MACE rates versus warfarin; differences were observed in stroke/SE and MB. Our findings provide insights about OAC therapy among NVAF patients with HF.

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Section: Discussionmentioning

confidence: 99%

Effectiveness and safety of oral anticoagulants in older adults with non-valvular atrial fibrillation and heart failure

Amin

Reeves

et al. 2019

PLoS ONE

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“…14 In contrast, the European AF registry (PREFER in AF-HF substudy) revealed that the risk of thromboembolic events was the highest in the HFrEF group, followed by the HFmrEF and HFpEF groups. 15 Epidemiological studies have reported a close relationship between AF and HFpEF. 16 Although it is not clear why the risk for stroke/SE was the highest in the HFpEF group in the present study, the following explanation may be plausible.…”

Section: Main Findingsmentioning

confidence: 99%

Stroke and systemic embolism in patients with atrial fibrillation and heart failure according to heart failure type

Uhm

Kim

et al. 2021

ESC Heart Failure

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Aims This study aimed to elucidate the risk for stroke and systemic embolism (SE) in patients with atrial fibrillation and heart failure (HF) according to HF type. Methods and results A total of 10 780 patients with atrial fibrillation were enrolled in a multicentre prospective registry and divided according to HF type: no-HF, HF with preserved ejection fraction (EF) (HFpEF), HF with mid-range EF (HFmrEF), and HF with reduced EF (HFrEF). Each group included 237 age-matched and sex-matched patients (age, 69.0 ± 10.3 years; men, 69.6%). The baseline characteristics, cumulative incidence, and hazard ratios for stroke/SE and major bleeding were compared across the groups. Patients with HF accounted for 10.3% of the total population; HFpEF, HFmrEF, and HFrEF represented 43.7%, 23.6%, and 32.7% of the patients with HF, respectively. The CHA 2 DS 2-VASc score was significantly higher in the HFpEF, HFmrEF, and HFrEF groups than in the no-HF group. The annual stroke/SE incidence rates were 2.8%, 0.7%, 1.1%, and 0.9% in the HFpEF, HFmrEF, HFrEF, and no-HF groups, respectively. The cumulative incidence of stroke/SE was significantly highest in the HFpEF group at 22.8 ± 10.0 months (P = 0.020). The stroke/SE risk was higher in the HFpEF group than in the HFmrEF and HFrEF groups (hazard ratio, 3.192; 95% confidence interval, 1.039-9.810; P = 0.043). E/e' value was an independent risk factor for stroke/SE. There were no significant differences in the incidence of major bleeding across the groups. Conclusions The stroke/SE risk was the highest in the HFpEF group and comparable between the HFmrEF and HFrEF groups.

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“…In patients with clinically overt heart failure (HF), atrial fibrillation (AF) affects ∼15-30% of patients (1). Concomitant occurrence of AF and HF significantly increases the risk of all-cause mortality, HF hospitalizations, and thromboembolism (1)(2)(3). Existing randomized controlled trials evaluating the effect of catheter ablation (CA) on outcomes in patients with AF and heart failure with reduced ejection fraction (HFrEF) have demonstrated a significant reduction in all-cause mortality and HF hospitalizations (4)(5)(6)(7)(8)(9)(10)(11).…”

Section: Introductionmentioning

confidence: 99%

Sex-Related Differences in Catheter Ablation for Patients With Atrial Fibrillation and Heart Failure

Chibber

Baranchuk

2020

Front. Cardiovasc. Med.

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The coexistence of atrial fibrillation and heart failure significantly increases the risk of all-cause mortality and heart failure hospitalizations. Sex-related differences in all patients undergoing atrial fibrillation catheter ablation include the referral of fewer women for catheter ablation (15–25%), older age of women at ablation, and higher risk of post-ablation recurrence of atrial fibrillation. We searched the existing literature for sex-related differences in patients undergoing atrial fibrillation catheter ablation with a focus on heart failure. Randomized controlled trials assessing atrial fibrillation catheter ablation in patients with heart failure have demonstrated a significant reduction in all-cause mortality and heart failure hospitalizations. Within the eight existing randomized controlled trials on heart failure with reduced ejection fraction, women composed a small proportion of the study population. Only two studies (CASTLE-AF and AATAC-HF) specifically assessed the effect of gender on outcome and showed no difference in post-ablation outcomes. Registry data-based studies assessing sex-related differences in atrial fibrillation catheter ablation in heart failure reveal that women are half as likely as men to undergo ablation. Conflicting data exist on the interaction of gender and heart failure as they may affect peri-ablation and post-ablation long-term outcomes such as atrial fibrillation recurrence or heart failure hospitalizations. In conclusion, existing studies provide insight into the gender-based differences in patients undergoing catheter ablation for atrial fibrillation as it pertains to heart failure. Further prospective studies with higher proportions of female participants are required to accurately determine gender-based differences in this population.

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Heart failure subtypes and thromboembolic risk in patients with atrial fibrillation: The PREFER in AF - HF substudy

Cited by 40 publications

References 39 publications

Effectiveness and safety of oral anticoagulants in older adults with non-valvular atrial fibrillation and heart failure

Effectiveness and safety of oral anticoagulants in older adults with non-valvular atrial fibrillation and heart failure

Stroke and systemic embolism in patients with atrial fibrillation and heart failure according to heart failure type

Sex-Related Differences in Catheter Ablation for Patients With Atrial Fibrillation and Heart Failure

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