Mid-Term Prognosis After Landiolol Treatment in Atrial Fibrillation/Atrial Flutter Patients With Chronic Heart Failure　― A Prospective Observational Survey (AF-CHF Landiolol Survey) ―

Abstract

Background: The aim of the prospective post-marketing AF-CHF Landiolol Survey was to evaluate the safety and effectiveness of landiolol for the treatment of atrial fibrillation or atrial flutter in patients with cardiac dysfunction in clinical practice in Japan. This analysis reports mid-term prognoses with a focus on switching from landiolol to oral β-blockers. Methods and Results: The AF-CHF Landiolol Survey took place between June 2014 and May 2016 and involved 1,121 patients with cardiac dysfunction and atrial fibrillation/atrial flutter. Data collected about switching from landiolol to oral β-blockers were analyzed in relation to all-cause mortality within 180 days after landiolol initiation. Among 1,002 patients with available follow-up data, the 6-month all-cause mortality rate was 14. 6% (n=146 patients), of whom 39.7% had died from heart failure (HF). Kaplan-Meier survival curves showed significantly longer survival in patients who had switched to oral β-blockers vs. those who had not, with hazard ratios of 0.39 (95% confidence interval [CI] 0.28–0.55) for all-cause mortality and 0.40 (95% CI: 0.23–0.70) for death from HF. Only male sex and advanced age were independently associated with all-cause mortality and death from HF. Conclusions: This large-scale routine practice survey of landiolol in HF patients with atrial fibrillation/flutter showed high mid-term all-cause mortality. Switching from landiolol to oral β-blockers was apparently, although not independently, associated with lower all-cause mortality and death from HF.

Benefits and safety of landiolol for rapid rate control in patients with atrial tachyarrhythmias and acute decompensated heart failure

“…also reported from a post-marketing survey that patients who were switched from landiolol to oral beta blockers had lower all-cause mortality and HF-specific mortality than those who were not switched [hazard ratio 0.39, 95% confidence interval (CI) 0.28–0.55; hazard ratio 0.40, 95% CI 0.23–0.70, respectively]. 38 Kiuchi et al . 19 reported that the latency to switch to oral beta blockers was shorter in patients receiving intravenous landiolol than in patients receiving intravenous diltiazem (median: 2 vs. 4 days, P = 0.002).…”

Intravenous Landiolol for Rate Control in Supraventricular Tachyarrhythmias in Patients with Left Ventricular Dysfunction: A Systematic Review and Meta-Analysis

“…Male sex and advanced age were independently associated with all-cause mortality and death from HF [ 23 ]…”