Secondary prevention and outcomes in outpatients with coronary artery disease, atrial fibrillation or heart failure: a focus on disease overlap

Abstract

ObjectiveTo assess secondary prevention and outcomes in patients with chronic coronary artery disease (CAD), atrial fibrillation (AF) and heart failure (HF), focusing on disease overlap.MethodsWe analysed the data of 10 517 outpatients with a diagnosis of CAD, AF and/or HF included in a prospective cohort study. Follow-up (median 3.2 years) was achieved in 10 478 (99.6%) patients. Seven mutually exclusive patient groups were formed: CAD alone (n=4303), AF alone (n=2604), CAD+AF (n=700), HF alone (n=513), HF+CAD (n=728), HF+AF (n=1087) and HF+CAD+AF (n=582).ResultsPatients with disease overlaps represented 29.4% of the total population. The level of secondary prevention was high in all subgroups and in accordance with European class I – level A guidelines. Among patients with CAD, 99% received an antithrombotic and 91% received a statin. Among patients with AF, 81.7% were treated with an anticoagulant if indicated. Among HF patients with left ventricular ejection fraction <40%, 90.9% received a renin-angiotensin system antagonist and 91% a beta-blocker. Three-year all cause/cardiovascular mortality rates were: 6.4%/2%, 9.7%/3.3%, 15.6%/6.7%, 19.2%/9.4%, 24.3%/13.6%, 28%/15.7% and 35.4%/24.8%, for patients with CAD alone, AF alone, CAD+AF, HF alone, HF+CAD, HF+AF and HF+CAD+AF, respectively. In all groups with HF, observed all-cause mortality was higher (p<0.0001) than expected mortality for age-matched, gender-matched and geography-matched persons. In contrast, observed mortality was lower than expected for patients with CAD alone and AF alone (p<0.0001).ConclusionsIn a context of adequate secondary prevention, overlap between diseases is a frequent and high-risk situation with incremental increases in mortality. These patients deserve specific attention.

Apolipoprotein Proteomic Profiling for the Prediction of Cardiovascular Death in Patients with Heart Failure

“…Heart failure (HF) represents a major public health problem. [ 1 ] Despite recent therapeutic improvements, mortality of HF patients remains high (above 25–30% at three years in real‐life registries) [ 2 ] and risk stratification is subsequently an important part of patient's management in clinical practice. [ 3,4 ] Indeed, patients at high risk may be considered for advanced HF therapies such as cardiac assistance or heart transplantation.…”

Relative Importance of Heart Failure Events Compared to Stroke and Bleeding in AF Patients

“…This study is a post-hoc analysis from the CARDIONOR study. The CARDIONOR study is a multicenter registry that prospectively enrolled 10,517 consecutive outpatients with a diagnosis of coronary artery disease (CAD), AF, and/or HF between January 2013 and May 2015 [ 9 ]. The study flow chart is provided in the Supplementary Materials (Figure S1) .…”

“…Hospitalization for HF was defined as hospitalization for symptoms of dyspnea or edema associated with bilateral rales, elevated venous pressure, interstitial or alveolar edema on chest X-ray, or the addition of intravenous diuretics or inotropic medications [ 9 ].…”

Real-Life Incident Atrial Fibrillation in Outpatients with Coronary Artery Disease

“…The CARDIONOR study is a multicenter registry that enrolled 10,517 consecutive outpatients with a diagnosis of CAD, AF, and/or heart failure (HF) between January 2013 and May 2015 [9]. The patients were included by 81 cardiologists from the French Region of Nord-Pas-de-Calais during outpatient visits.…”