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Outcomes of patients with atrial fibrillation on oral anticoagulation with and without heart failure: the ETNA-AF-Europe registry
Abstract Aims Heart failure (HF) is a risk factor for major adverse events in atrial fibrillation (AF). Whether this risk persists on non-vitamin K antagonist oral anticoagulants (NOACs) and varies according to left ventricular ejection fraction (LVEF) is debated. Methods and results We investigated...
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| Published in: | Europace (London, England) England), 2023-08, Vol.25 (9) |
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| creator | Schnabel, Renate B Ameri, Pietro Siller-Matula, Jolanta M Diemberger, Igor Gwechenberger, Marianne Pecen, Ladislav Manu, Marius Constantin Souza, José De Caterina, Raffaele Kirchhof, Paulus |
| description | Abstract
Aims
Heart failure (HF) is a risk factor for major adverse events in atrial fibrillation (AF). Whether this risk persists on non-vitamin K antagonist oral anticoagulants (NOACs) and varies according to left ventricular ejection fraction (LVEF) is debated.
Methods and results
We investigated the relation of HF in the ETNA-AF-Europe registry, a prospective, multicentre, observational study with an overall 4-year follow-up of edoxaban-treated AF patients. We report 2-year follow-up for ischaemic stroke/transient ischaemic attack (TIA)/systemic embolic events (SEE), major bleeding, and mortality. Of the 13 133 patients, 1854 (14.1%) had HF. Left ventricular ejection fraction was available for 82.4% of HF patients and was |
| doi_str_mv | 10.1093/europace/euad280 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_10540669</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><oup_id>10.1093/europace/euad280</oup_id><sourcerecordid>2865782048</sourcerecordid><originalsourceid>FETCH-LOGICAL-c433t-4d3e2a02aec61d0609547b652606b3184baaa670b5ae139416fdfa320f81fb7c3</originalsourceid><addsrcrecordid>eNqFUcFu1DAQtRAVLYU7J-QjEgod24kTc0GragtIFb2UszVx7F2jbBxsB9Qjf46X3Vb0VMmSn2bePM_zI-QNgw8MlLiwSwwzGlsADryDZ-SMNYJXHBR_XjAoVTWMq1PyMqUfANBy1bwgp6JtmWAdPyN_bpZsws4mGhydMXs75UR_-7ylmKPHkTrfRz-OpRUmuj-xFHHK3gTcLMf6YWAa_oGwZLq1GDN16Mcl2o80by1d335bVaurar1f2tJoNz7lePeKnDgck319vM_J96v17eWX6vrm89fL1XVlaiFyVQ_CcgSO1kg2gATV1G0vGy5B9sVL3SOibKFv0DKhaibd4FBwcB1zfWvEOfl00J2XfmcHU4wWJ3qOfofxTgf0-nFn8lu9Cb80g6YGKVVReHdUiOHnYlPWO5-MLX8z2bAkzTvZtB2HuitUOFBNDClF6x7eYaD30en76PQxujLy9v_9HgbusyqE9wdCWOan5f4C_COqpA</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2865782048</pqid></control><display><type>article</type><title>Outcomes of patients with atrial fibrillation on oral anticoagulation with and without heart failure: the ETNA-AF-Europe registry</title><source>Oxford Journals Open Access Collection</source><source>Oxford Journals Online</source><source>PubMed Central</source><creator>Schnabel, Renate B ; Ameri, Pietro ; Siller-Matula, Jolanta M ; Diemberger, Igor ; Gwechenberger, Marianne ; Pecen, Ladislav ; Manu, Marius Constantin ; Souza, José ; De Caterina, Raffaele ; Kirchhof, Paulus</creator><creatorcontrib>Schnabel, Renate B ; Ameri, Pietro ; Siller-Matula, Jolanta M ; Diemberger, Igor ; Gwechenberger, Marianne ; Pecen, Ladislav ; Manu, Marius Constantin ; Souza, José ; De Caterina, Raffaele ; Kirchhof, Paulus</creatorcontrib><description>Abstract
Aims
Heart failure (HF) is a risk factor for major adverse events in atrial fibrillation (AF). Whether this risk persists on non-vitamin K antagonist oral anticoagulants (NOACs) and varies according to left ventricular ejection fraction (LVEF) is debated.
Methods and results
We investigated the relation of HF in the ETNA-AF-Europe registry, a prospective, multicentre, observational study with an overall 4-year follow-up of edoxaban-treated AF patients. We report 2-year follow-up for ischaemic stroke/transient ischaemic attack (TIA)/systemic embolic events (SEE), major bleeding, and mortality. Of the 13 133 patients, 1854 (14.1%) had HF. Left ventricular ejection fraction was available for 82.4% of HF patients and was <40% in 671 (43.9%) and ≥40% in 857 (56.1%). Patients with HF were older, more often men, and had more comorbidities. Annualized event rates (AnERs) of any stroke/SEE were 0.86%/year and 0.67%/year in patients with and without HF. Compared with patients without HF, those with HF also had higher AnERs for major bleeding (1.73%/year vs. 0.86%/year) and all-cause death (8.30%/year vs. 3.17%/year). Multivariate Cox proportional models confirmed HF as a significant predictor of major bleeding [hazard ratio (HR) 1.65, 95% confidence interval (CI): 1.20–2.26] and all-cause death [HF with LVEF <40% (HR 2.42, 95% CI: 1.95–3.00) and HF with LVEF ≥40% (HR 1.80, 95% CI: 1.45–2.23)] but not of ischaemic stroke/TIA/SEE.
Conclusion
Anticoagulated patients with HF at baseline featured higher rates of major bleeding and all-cause death, requiring optimized management and novel preventive strategies. NOAC treatment was similarly effective in reducing risk of ischaemic events in patients with or without concomitant HF.
Graphical Abstract
Graphical Abstract</description><identifier>ISSN: 1099-5129</identifier><identifier>ISSN: 1532-2092</identifier><identifier>EISSN: 1532-2092</identifier><identifier>DOI: 10.1093/europace/euad280</identifier><identifier>PMID: 37713182</identifier><language>eng</language><publisher>US: Oxford University Press</publisher><subject>Administration, Oral ; Anticoagulants - adverse effects ; Atrial Fibrillation - complications ; Atrial Fibrillation - diagnosis ; Atrial Fibrillation - drug therapy ; Brain Ischemia ; Clinical Research ; Embolism ; Heart Failure - diagnosis ; Heart Failure - epidemiology ; Hemorrhage - chemically induced ; Humans ; Ischemic Attack, Transient - diagnosis ; Ischemic Attack, Transient - epidemiology ; Ischemic Attack, Transient - prevention & control ; Ischemic Stroke ; Male ; Prospective Studies ; Registries ; Stroke - diagnosis ; Stroke - epidemiology ; Stroke - etiology ; Stroke Volume - physiology ; Ventricular Function, Left</subject><ispartof>Europace (London, England), 2023-08, Vol.25 (9)</ispartof><rights>The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. 2023</rights><rights>The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c433t-4d3e2a02aec61d0609547b652606b3184baaa670b5ae139416fdfa320f81fb7c3</citedby><cites>FETCH-LOGICAL-c433t-4d3e2a02aec61d0609547b652606b3184baaa670b5ae139416fdfa320f81fb7c3</cites><orcidid>0000-0001-7167-7287 ; 0000-0002-1881-0197 ; 0000-0001-7170-9509 ; 0000-0001-9827-3178 ; 0000-0003-1637-574X ; 0000-0001-6041-1635 ; 0000-0002-3823-3809</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10540669/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10540669/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,881,1598,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37713182$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Schnabel, Renate B</creatorcontrib><creatorcontrib>Ameri, Pietro</creatorcontrib><creatorcontrib>Siller-Matula, Jolanta M</creatorcontrib><creatorcontrib>Diemberger, Igor</creatorcontrib><creatorcontrib>Gwechenberger, Marianne</creatorcontrib><creatorcontrib>Pecen, Ladislav</creatorcontrib><creatorcontrib>Manu, Marius Constantin</creatorcontrib><creatorcontrib>Souza, José</creatorcontrib><creatorcontrib>De Caterina, Raffaele</creatorcontrib><creatorcontrib>Kirchhof, Paulus</creatorcontrib><title>Outcomes of patients with atrial fibrillation on oral anticoagulation with and without heart failure: the ETNA-AF-Europe registry</title><title>Europace (London, England)</title><addtitle>Europace</addtitle><description>Abstract
Aims
Heart failure (HF) is a risk factor for major adverse events in atrial fibrillation (AF). Whether this risk persists on non-vitamin K antagonist oral anticoagulants (NOACs) and varies according to left ventricular ejection fraction (LVEF) is debated.
Methods and results
We investigated the relation of HF in the ETNA-AF-Europe registry, a prospective, multicentre, observational study with an overall 4-year follow-up of edoxaban-treated AF patients. We report 2-year follow-up for ischaemic stroke/transient ischaemic attack (TIA)/systemic embolic events (SEE), major bleeding, and mortality. Of the 13 133 patients, 1854 (14.1%) had HF. Left ventricular ejection fraction was available for 82.4% of HF patients and was <40% in 671 (43.9%) and ≥40% in 857 (56.1%). Patients with HF were older, more often men, and had more comorbidities. Annualized event rates (AnERs) of any stroke/SEE were 0.86%/year and 0.67%/year in patients with and without HF. Compared with patients without HF, those with HF also had higher AnERs for major bleeding (1.73%/year vs. 0.86%/year) and all-cause death (8.30%/year vs. 3.17%/year). Multivariate Cox proportional models confirmed HF as a significant predictor of major bleeding [hazard ratio (HR) 1.65, 95% confidence interval (CI): 1.20–2.26] and all-cause death [HF with LVEF <40% (HR 2.42, 95% CI: 1.95–3.00) and HF with LVEF ≥40% (HR 1.80, 95% CI: 1.45–2.23)] but not of ischaemic stroke/TIA/SEE.
Conclusion
Anticoagulated patients with HF at baseline featured higher rates of major bleeding and all-cause death, requiring optimized management and novel preventive strategies. NOAC treatment was similarly effective in reducing risk of ischaemic events in patients with or without concomitant HF.
Graphical Abstract
Graphical Abstract</description><subject>Administration, Oral</subject><subject>Anticoagulants - adverse effects</subject><subject>Atrial Fibrillation - complications</subject><subject>Atrial Fibrillation - diagnosis</subject><subject>Atrial Fibrillation - drug therapy</subject><subject>Brain Ischemia</subject><subject>Clinical Research</subject><subject>Embolism</subject><subject>Heart Failure - diagnosis</subject><subject>Heart Failure - epidemiology</subject><subject>Hemorrhage - chemically induced</subject><subject>Humans</subject><subject>Ischemic Attack, Transient - diagnosis</subject><subject>Ischemic Attack, Transient - epidemiology</subject><subject>Ischemic Attack, Transient - prevention & control</subject><subject>Ischemic Stroke</subject><subject>Male</subject><subject>Prospective Studies</subject><subject>Registries</subject><subject>Stroke - diagnosis</subject><subject>Stroke - epidemiology</subject><subject>Stroke - etiology</subject><subject>Stroke Volume - physiology</subject><subject>Ventricular Function, Left</subject><issn>1099-5129</issn><issn>1532-2092</issn><issn>1532-2092</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>TOX</sourceid><recordid>eNqFUcFu1DAQtRAVLYU7J-QjEgod24kTc0GragtIFb2UszVx7F2jbBxsB9Qjf46X3Vb0VMmSn2bePM_zI-QNgw8MlLiwSwwzGlsADryDZ-SMNYJXHBR_XjAoVTWMq1PyMqUfANBy1bwgp6JtmWAdPyN_bpZsws4mGhydMXs75UR_-7ylmKPHkTrfRz-OpRUmuj-xFHHK3gTcLMf6YWAa_oGwZLq1GDN16Mcl2o80by1d335bVaurar1f2tJoNz7lePeKnDgck319vM_J96v17eWX6vrm89fL1XVlaiFyVQ_CcgSO1kg2gATV1G0vGy5B9sVL3SOibKFv0DKhaibd4FBwcB1zfWvEOfl00J2XfmcHU4wWJ3qOfofxTgf0-nFn8lu9Cb80g6YGKVVReHdUiOHnYlPWO5-MLX8z2bAkzTvZtB2HuitUOFBNDClF6x7eYaD30en76PQxujLy9v_9HgbusyqE9wdCWOan5f4C_COqpA</recordid><startdate>20230802</startdate><enddate>20230802</enddate><creator>Schnabel, Renate B</creator><creator>Ameri, Pietro</creator><creator>Siller-Matula, Jolanta M</creator><creator>Diemberger, Igor</creator><creator>Gwechenberger, Marianne</creator><creator>Pecen, Ladislav</creator><creator>Manu, Marius Constantin</creator><creator>Souza, José</creator><creator>De Caterina, Raffaele</creator><creator>Kirchhof, Paulus</creator><general>Oxford University Press</general><scope>TOX</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0001-7167-7287</orcidid><orcidid>https://orcid.org/0000-0002-1881-0197</orcidid><orcidid>https://orcid.org/0000-0001-7170-9509</orcidid><orcidid>https://orcid.org/0000-0001-9827-3178</orcidid><orcidid>https://orcid.org/0000-0003-1637-574X</orcidid><orcidid>https://orcid.org/0000-0001-6041-1635</orcidid><orcidid>https://orcid.org/0000-0002-3823-3809</orcidid></search><sort><creationdate>20230802</creationdate><title>Outcomes of patients with atrial fibrillation on oral anticoagulation with and without heart failure: the ETNA-AF-Europe registry</title><author>Schnabel, Renate B ; Ameri, Pietro ; Siller-Matula, Jolanta M ; Diemberger, Igor ; Gwechenberger, Marianne ; Pecen, Ladislav ; Manu, Marius Constantin ; Souza, José ; De Caterina, Raffaele ; Kirchhof, Paulus</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c433t-4d3e2a02aec61d0609547b652606b3184baaa670b5ae139416fdfa320f81fb7c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Administration, Oral</topic><topic>Anticoagulants - adverse effects</topic><topic>Atrial Fibrillation - complications</topic><topic>Atrial Fibrillation - diagnosis</topic><topic>Atrial Fibrillation - drug therapy</topic><topic>Brain Ischemia</topic><topic>Clinical Research</topic><topic>Embolism</topic><topic>Heart Failure - diagnosis</topic><topic>Heart Failure - epidemiology</topic><topic>Hemorrhage - chemically induced</topic><topic>Humans</topic><topic>Ischemic Attack, Transient - diagnosis</topic><topic>Ischemic Attack, Transient - epidemiology</topic><topic>Ischemic Attack, Transient - prevention & control</topic><topic>Ischemic Stroke</topic><topic>Male</topic><topic>Prospective Studies</topic><topic>Registries</topic><topic>Stroke - diagnosis</topic><topic>Stroke - epidemiology</topic><topic>Stroke - etiology</topic><topic>Stroke Volume - physiology</topic><topic>Ventricular Function, Left</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Schnabel, Renate B</creatorcontrib><creatorcontrib>Ameri, Pietro</creatorcontrib><creatorcontrib>Siller-Matula, Jolanta M</creatorcontrib><creatorcontrib>Diemberger, Igor</creatorcontrib><creatorcontrib>Gwechenberger, Marianne</creatorcontrib><creatorcontrib>Pecen, Ladislav</creatorcontrib><creatorcontrib>Manu, Marius Constantin</creatorcontrib><creatorcontrib>Souza, José</creatorcontrib><creatorcontrib>De Caterina, Raffaele</creatorcontrib><creatorcontrib>Kirchhof, Paulus</creatorcontrib><collection>Oxford Journals Open Access Collection</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Europace (London, England)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Schnabel, Renate B</au><au>Ameri, Pietro</au><au>Siller-Matula, Jolanta M</au><au>Diemberger, Igor</au><au>Gwechenberger, Marianne</au><au>Pecen, Ladislav</au><au>Manu, Marius Constantin</au><au>Souza, José</au><au>De Caterina, Raffaele</au><au>Kirchhof, Paulus</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Outcomes of patients with atrial fibrillation on oral anticoagulation with and without heart failure: the ETNA-AF-Europe registry</atitle><jtitle>Europace (London, England)</jtitle><addtitle>Europace</addtitle><date>2023-08-02</date><risdate>2023</risdate><volume>25</volume><issue>9</issue><issn>1099-5129</issn><issn>1532-2092</issn><eissn>1532-2092</eissn><abstract>Abstract
Aims
Heart failure (HF) is a risk factor for major adverse events in atrial fibrillation (AF). Whether this risk persists on non-vitamin K antagonist oral anticoagulants (NOACs) and varies according to left ventricular ejection fraction (LVEF) is debated.
Methods and results
We investigated the relation of HF in the ETNA-AF-Europe registry, a prospective, multicentre, observational study with an overall 4-year follow-up of edoxaban-treated AF patients. We report 2-year follow-up for ischaemic stroke/transient ischaemic attack (TIA)/systemic embolic events (SEE), major bleeding, and mortality. Of the 13 133 patients, 1854 (14.1%) had HF. Left ventricular ejection fraction was available for 82.4% of HF patients and was <40% in 671 (43.9%) and ≥40% in 857 (56.1%). Patients with HF were older, more often men, and had more comorbidities. Annualized event rates (AnERs) of any stroke/SEE were 0.86%/year and 0.67%/year in patients with and without HF. Compared with patients without HF, those with HF also had higher AnERs for major bleeding (1.73%/year vs. 0.86%/year) and all-cause death (8.30%/year vs. 3.17%/year). Multivariate Cox proportional models confirmed HF as a significant predictor of major bleeding [hazard ratio (HR) 1.65, 95% confidence interval (CI): 1.20–2.26] and all-cause death [HF with LVEF <40% (HR 2.42, 95% CI: 1.95–3.00) and HF with LVEF ≥40% (HR 1.80, 95% CI: 1.45–2.23)] but not of ischaemic stroke/TIA/SEE.
Conclusion
Anticoagulated patients with HF at baseline featured higher rates of major bleeding and all-cause death, requiring optimized management and novel preventive strategies. NOAC treatment was similarly effective in reducing risk of ischaemic events in patients with or without concomitant HF.
Graphical Abstract
Graphical Abstract</abstract><cop>US</cop><pub>Oxford University Press</pub><pmid>37713182</pmid><doi>10.1093/europace/euad280</doi><orcidid>https://orcid.org/0000-0001-7167-7287</orcidid><orcidid>https://orcid.org/0000-0002-1881-0197</orcidid><orcidid>https://orcid.org/0000-0001-7170-9509</orcidid><orcidid>https://orcid.org/0000-0001-9827-3178</orcidid><orcidid>https://orcid.org/0000-0003-1637-574X</orcidid><orcidid>https://orcid.org/0000-0001-6041-1635</orcidid><orcidid>https://orcid.org/0000-0002-3823-3809</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Europace (London, England), 2023-08, Vol.25 (9) |
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| language | eng |
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| source | Oxford Journals Open Access Collection; Oxford Journals Online; PubMed Central |
| subjects | Administration, Oral Anticoagulants - adverse effects Atrial Fibrillation - complications Atrial Fibrillation - diagnosis Atrial Fibrillation - drug therapy Brain Ischemia Clinical Research Embolism Heart Failure - diagnosis Heart Failure - epidemiology Hemorrhage - chemically induced Humans Ischemic Attack, Transient - diagnosis Ischemic Attack, Transient - epidemiology Ischemic Attack, Transient - prevention & control Ischemic Stroke Male Prospective Studies Registries Stroke - diagnosis Stroke - epidemiology Stroke - etiology Stroke Volume - physiology Ventricular Function, Left |
| title | Outcomes of patients with atrial fibrillation on oral anticoagulation with and without heart failure: the ETNA-AF-Europe registry |
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