Improving survival for patients with atrial fibrillation and advanced heart failure

Stevenson, William G.; Stevenson, Lynne Warner; Middlekauff, Holly R.; Fonarow, Gregg C.; Hamilton, Michelle A.; Woo, Mary A.; Saxon, Leslie A.; Natterson, Paul D.; Steimle, Anthony; Walden, Julie; Tillisch, Jan H.

doi:10.1016/s0735-1097(96)00358-0

Cited by 208 publications

(95 citation statements)

References 29 publications

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“…3,5,7 In the present study, 70% of the patients were administered angiotensin-converting enzyme inhibitor or angiotensin II type 1 receptor blocker as the basic treatment of heart failure and these drugs may also be beneficial in the management of heart failure and AF through their reduction of neurohormonal activation. 1,3 Our result of 59% of patients successfully maintaining SR while on low-dose amiodarone during a mean followup of 18 months is comparable with the results of previous studies (53-79%). [22][23][24][25][26][27][28][29][30] However, unlike the previous studies in which recurrence increased linearly, our results are characterized by the first recurrence most often occurring within 1 year of initiating amiodarone therapy and the reasons for this difference may include: (1) a lower maintenance dose of amiodarone than previously reported (200-400 mg/day); 29 (2) symptomatic heart failure and left ventricular dysfunction in all patients in the present study; and (3) many of the present patients had nonischemic heart disease.…”

Section: Discussionsupporting

confidence: 90%

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Effect of Low-Dose Amiodarone on Atrial Fibrillation or Flutter in Japanese Patients With Heart Failure.

Shiga

Wakaumi

Imai

et al. 2002

Circ J

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The efficacy and safety of amiodarone in the management of atrial fibrillation (AF) or flutter in 108 Japanese patients with heart failure was retrospectively examined. Thirty-four (41%) of the 82 patients who were in sinus rhythm after 1 month of amiodarone administration had their first recurrence, 70% of cases occurring within 1 year of initiation. The cumulative rates of maintenance of sinus rhythm were 0.68, 0.55, and 0.47 at 1, 3, and 5 years, respectively. Amiodarone was more effective in maintaining sinus rhythm in patients with paroxysmal AF or flutter than in those with the persistent form (p<0.05). The cumulative rates for cases that remained in permanent AF were 0.04, 0.11, and 0.14 at 1, 3, and 5 years, respectively. Apart from suppressing AF, the mean heart rate during Holter monitoring was significantly decreased with amiodarone therapy in cases of permanent AF. Adverse effects requiring the discontinuation of amiodarone therapy occurred in 16% of patients. Low-dose amiodarone therapy may prevent AF or flutter in Japanese patients with heart failure. (Circ J 2002; 66: 600 -604)

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Section: Discussionsupporting

confidence: 90%

“…1 During the 40 years of follow-up in the Framingham study, 21.8% of male and 28.9% of female subjects with AF developed heart failure, compared with only 3.2% and 3.7%, respectively, of those without AF. 2 However, there are no reports concerning the incidence of AF or its prognosis in Japanese patients with heart failure.…”

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confidence: 99%

Effect of Low-Dose Amiodarone on Atrial Fibrillation or Flutter in Japanese Patients With Heart Failure.

Shiga

Wakaumi

Imai

et al. 2002

Circ J

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“…However, many studies have reported that the use of these drugs to suppress AF resulted in worsening prognosis although the drugs exhibit strong antiarrhythmic effects. [13][14][15][16] In addition to a worsening prognosis, these drugs may induce a risk of serious ventricular arrhythmia, eg, torsade de points, as a side effect. Recently, the effectiveness of β-blockers in the treatment of persistent AF has been reevaluated since several large-scale studies revealed that rate control therapy using a drug such as a β-blocker proved not to be inferior to rhythm control therapy using an antiarrhythmic drug in terms of the incidence of serious events such as cerebral infarction.…”

Section: Discussionmentioning

confidence: 99%

Antiarrhythmic Effect of Bisoprolol, a Highly Selective .BETA.1-Blocker, in Patients With Paroxysmal Atrial Fibrillation

et al. 2008

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SUMMARYIn the treatment of arrhythmia, β-blockers are mainly used to regulate the heart rate. However, β-blockers are also known as drugs with an antiarrhythmic effect due to the suppression of sympathetic activity. We evaluated the antiarrhythmic effects of a highly selective β 1 -blocker, bisoprolol, in patients with diurnal paroxysmal atrial fibrillation (P-AF).A total of 136 patients with symptomatic diurnal P-AF were enrolled. Patients were divided into a diurnal-specific P-AF group and a diurnal & nocturnal P-AF group, as well as into a bisoprolol single use group and a combined use group with an antiarrhythmic drug. The effects of bisoprolol were evaluated in 3 categories: subjective symptom improvement, quality of life (QOL) improvement, and elimination of P-AF episode in Holter electrocardiograms (ECGs). For patients with effective treatment, a long-term effect up to 24 months was evaluated.Five patients (3.7%) discontinued bisoprolol due to side effects. Following administration of bisoprolol, 109 patients (80%) experienced subjective symptom improvement, 103 patients (76%) experienced QOL improvement, and elimination of P-AF episodes in ECGs was observed in 84 patients (62%). The elimination rate of P-AF episodes in ECGs was higher in the diurnal P-AF group than in the diurnal & nocturnal P-AF group (P = 0.042). There was no significant difference between the bisoprolol single use group and the combined use group. A long-term suppressive effect by bisoprolol was observed in 70 of 83 patients (84%).The results demonstrate that bisoprolol has an antiarrhythmic effect against sympathetic diurnal P-AF, improving subjective symptoms and QOL and eliminating P-AF episodes in ECGs. (Int Heart J 2008; 49: 281-293)

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“…Similarly, a recent report attributed a trend toward better prognosis among patients with heart failure (unrelated to AMI) and PAF in the 1990s to improvements in medical treatment. 30 …”

Section: Study Limitationsmentioning

confidence: 99%

Significance of Paroxysmal Atrial Fibrillation Complicating Acute Myocardial Infarction in the Thrombolytic Era

et al. 1998

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Background-Paroxysmal atrial fibrillation (PAF) is considered a frequent complication of acute myocardial infarction (AMI), associated with increased in-hospital and long-term mortality rates. This notion is based on data collected before thrombolysis and additional modern methods of treatment became widely available, and no information is available on the significance of PAF in the general population with AMI in the thrombolytic era. The aim of the present study was to define the incidence, associated clinical parameters, and short-and long-term prognostic significance of PAF in patients with AMI in the thrombolytic era. Methods and Results-A prospective, nationwide survey was conducted of 2866 consecutive patients admitted with AMI in all 25 coronary care units in Israel during January/February 1992). The data were compared with a previous Israeli study of 5803 patients with AMI hospitalized in 1981 through 1983 (prethrombolytic era [PTE]). Patients in the TE with PAF were older and had a worse risk profile than those without PAF. PAF in the TE was independently associated with increased 30-day (odds ratio, 1.32; 95% confidence interval, 0.92 to 1.87) and 1-year (relative risk, 1.33; 95% confidence interval, 1.05 to 1.68) mortality rates. The incidence of PAF (8.9% and 9.9%) and the 30-day (25.1% and 27.6%) and 1-year (38.4% and 42.5%) mortality rates of patients with PAF were similar in the TE and PTE, although PAF in the TE occurred in older and sicker patients than those in the PTE. After adjustment for conventional risk factors, PAF was associated with significantly lower 30-day (odds ratio, 0.64; 95% confidence interval, 0.44 to 0.94) and 1-year (relative risk, 0.69; 95% confidence interval, 0.54 to 0.88) mortality rates compared with the PTE. Conclusions-Patients with AMI who develop PAF in the TE have significantly worse short-and long-term prognoses than patients without PAF, mostly due to their worse risk profile. After adjustment for confounding factors, patients with PAF in the TE have a better overall outcome than counterparts in the PTE, probably reflecting the better management of patients with AMI in the TE. (Circulation. 1998;97:965-970.)

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Improving survival for patients with atrial fibrillation and advanced heart failure

Abstract: The prognosis of patients with advanced heart failure and atrial fibrillation is improving. These findings support the practice of avoiding class I antiarrhythmic drugs in this group and may reflect recent beneficial changes in heart failure therapy.

Cited by 208 publications

References 29 publications

Effect of Low-Dose Amiodarone on Atrial Fibrillation or Flutter in Japanese Patients With Heart Failure.

Effect of Low-Dose Amiodarone on Atrial Fibrillation or Flutter in Japanese Patients With Heart Failure.

Antiarrhythmic Effect of Bisoprolol, a Highly Selective .BETA.1-Blocker, in Patients With Paroxysmal Atrial Fibrillation

Significance of Paroxysmal Atrial Fibrillation Complicating Acute Myocardial Infarction in the Thrombolytic Era

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