Valsartan reduces the incidence of atrial fibrillation in patients with heart failure: Results from the Valsartan Heart Failure Trial (Val-HeFT)

• Published in: The American heart journal 2005-03, Vol.149 (3), p.548-557
• Main Authors: Maggioni, Aldo P., Latini, Roberto, Carson, Peter E., Singh, Steven N., Barlera, Simona, Glazer, Robert, Masson, Serge, Cerè, Elisabetta, Tognoni, Gianni, Cohn, Jay N.
• Format: Article
• Language: English
• Subjects: Aged; Atrial Fibrillation - diagnosis; Atrial Fibrillation - epidemiology; Atrial Fibrillation - prevention & control; Biological and medical sciences; Cardiac arrhythmia; Cardiac dysrhythmias; Cardiology. Vascular system; Comorbidity; Drug therapy; Electrocardiography; Female; Heart; Heart attacks; Heart Failure - drug therapy; Heart Failure - epidemiology; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Humans; Incidence; Male; Medical sciences; Middle Aged; Mortality; Prognosis; Randomized Controlled Trials as Topic; Retrospective Studies; Risk Assessment; Survival Rate; Tetrazoles - therapeutic use; Treatment Outcome; Valine - analogs & derivatives; Valine - therapeutic use; Valsartan
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/j.ahj.2004.09.033

Atrial fibrillation (AF) in heart failure (HF) is generally considered a negative prognostic factor. Recent studies indicate that the incidence of AF might be decreased by renin angiotensin aldosterone system inhibitors. The identification of a treatment to prevent its occurrence is likely to improve patients outcome. The aims of these subanalyses of Val-HeFT were to assess ( a) the effects of valsartan in the prevention of AF, ( b) the independent predictors of this event, and ( c) the prognostic role of AF occurrence. The occurrence of AF was evaluated based on adverse event reports in the patients with HF enrolled in Val-HeFT. Patients were randomized to valsartan or placebo on top of their prescribed treatments for HF. During the mean 23 months of follow-up, AF was reported in 287/4395 patients (6.53%) in sinus rhythm at baseline, of whom 113/2205 (5.12%) were allocated to valsartan and 174/2190 (7.95%) to placebo ( P = .0002). Multivariable analysis showed that brain natriuretic peptide (BNP) levels at baseline above the median value (HR 2.28, 95% CI 1.75-2.98), age over 70 years (HR 1.51, 95% CI 1.17-1.95), male sex (HR 1.53, 95% CI 1.07-2.18), and the valsartan treatment (HR 0.63, 95% CI 0.49-0.81) were independently associated with AF occurrence. Cox multivariable regression analysis showed that occurrence of AF was independently associated with a worse prognosis, with the adjusted hazard risks for all-cause mortality and combined mortality/morbidity of 1.40 (95% CI 1.16-1.58) and 1.38 (95% CI 1.12-1.70), respectively. The results of the present study demonstrate that ( a) adding valsartan to prescribed therapy for HF significantly reduces the incidence of AF by 37%; ( b) BNP level and advanced age were the strongest independent predictors for AF occurrence; and ( c) AF occurrence further worsens the outcome in patients with HF.