Incidence and Predictors of Heart Failure in Patients With Atrial Fibrillation

• Published in: CJC open (Online) 2021-12, Vol.3 (12), p.1482-1489
• Main Authors: Krisai, Philipp, Johnson, Linda S.B., Moschovitis, Giorgio, Benz, Alexander, Ramasundarahettige, Chinthanie, McIntyre, William F., Wong, Jorge A., Conen, David, Sticherling, Christian, Connolly, Stuart J., Healey, Jeff S.
• Format: Article
• Language: English
• Subjects: Cardiac and Cardiovascular Systems; Clinical Medicine; Kardiologi; Klinisk medicin; Medical and Health Sciences; Medicin och hälsovetenskap; Original
• ISSN: 2589-790X; 2589-790X
• DOI: 10.1016/j.cjco.2021.07.016

Heart failure (HF) is a frequent cause of hospitalization and death in patients with atrial fibrillation (AF). Identifying AF patients at risk of HF hospitalization could help select individuals for intensive follow-up and treatment. We pooled data from 3 randomized trials (ACTIVE-A, RE-LY, AVERROES) of AF patients, for derivation and internal validation of a risk score for first HF hospitalization. Secondary endpoints were cardiovascular death and a composite of HF hospitalizations and cardiovascular death. In 23,503 patients, the mean age was 71.3 years, and 62% were male. Over a mean follow-up of 2.0 years, 875 patients (3.7%) experienced their first HF hospitalization, and 1037 patients (4.4%) died from cardiovascular causes. Incidence rates per 100 patient-years were 1.85 for HF hospitalizations, 2.15 for cardiovascular death, and 3.71 for the composite. Independent predictors for HF hospitalizations included the following: increased age, weight, heart rate and serum creatinine level, lower height and systolic blood pressure, diabetes, vascular disease, valvular disease, heart rhythm, left ventricular hypertrophy, and intraventricular conduction delay. The C-statistic (95% confidence intervals by bootstrap simulations) was 0.717 (0.705-0.732). At 2 years of follow-up, the incidence rate of the primary outcome increased across risk-score quintiles: 0.49, 0.87, 1.29, 2.44, and 4.51 per 100 patient-years, respectively. Patients in the highest quintile had an absolute risk of 6.8% for the primary endpoint at 2 years. In a large AF population, new-onset HF was common. A combination of characteristics can identify high-risk patients for whom strategies to prevent HF should be considered. L’insuffisance cardiaque (IC) est une cause fréquente d’hospitalisation et de décès chez les patients atteints de fibrillation auriculaire (FA). Le repérage des patients atteints de FA exposés au risque d’hospitalisation liée à l’IC pourrait faciliter la sélection des individus pour un suivi et un traitement intensifs. Nous avons regroupé les données de trois essais contrôlés (ACTIVE-A, RE-LY, AVERROES) de patients atteints de FA pour obtenir la dérivation et la validation interne d’un score de risque lors de la première hospitalisation liée à l’IC. Les critères secondaires étaient les décès dus aux maladies cardiovasculaires et le critère composite d’hospitalisations liées à l’IC et de décès dus aux maladies cardiovasculaires. L’âge moyen des 23 503 patients, dont 62 % éta