Outcomes of patients with atrial fibrillation on oral anticoagulation with and without heart failure
Standard
Outcomes of patients with atrial fibrillation on oral anticoagulation with and without heart failure : the ETNA-AF-Europe registry. / 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; ETNA-AF-Europe investigators.
in: EUROPACE, Jahrgang 25, Nr. 9, 02.08.2023.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
Harvard
APA
Vancouver
Bibtex
}
RIS
TY - JOUR
T1 - Outcomes of patients with atrial fibrillation on oral anticoagulation with and without heart failure
T2 - the ETNA-AF-Europe registry
AU - Schnabel, Renate B
AU - Ameri, Pietro
AU - Siller-Matula, Jolanta M
AU - Diemberger, Igor
AU - Gwechenberger, Marianne
AU - Pecen, Ladislav
AU - Manu, Marius Constantin
AU - Souza, José
AU - De Caterina, Raffaele
AU - Kirchhof, Paulus
AU - ETNA-AF-Europe investigators
N1 - © The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.
PY - 2023/8/2
Y1 - 2023/8/2
N2 - 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.
AB - 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.
KW - Male
KW - Humans
KW - Atrial Fibrillation/complications
KW - Stroke/diagnosis
KW - Anticoagulants/adverse effects
KW - Ischemic Attack, Transient/diagnosis
KW - Brain Ischemia
KW - Prospective Studies
KW - Stroke Volume/physiology
KW - Administration, Oral
KW - Ventricular Function, Left
KW - Hemorrhage/chemically induced
KW - Embolism
KW - Ischemic Stroke
KW - Heart Failure/diagnosis
KW - Registries
U2 - 10.1093/europace/euad280
DO - 10.1093/europace/euad280
M3 - SCORING: Journal article
C2 - 37713182
VL - 25
JO - EUROPACE
JF - EUROPACE
SN - 1099-5129
IS - 9
ER -