TY - JOUR
T1 - History of Atrial Fibrillation and Trajectory of Decongestion in Acute Heart Failure
AU - Patel, Ravi B.
AU - Vaduganathan, Muthiah
AU - Rikhi, Aruna
AU - Chakraborty, Hrishikesh
AU - Greene, Stephen J.
AU - Hernandez, Adrian F.
AU - Felker, G. Michael
AU - Redfield, Margaret M.
AU - Butler, Javed
AU - Shah, Sanjiv J.
N1 - Funding Information:
Supported by National Heart, Lung, and Blood Institute/National Institutes of Health awards U10 HL084904, U10 HL110297, U10 HL110342, U10 HL110309, U10 HL110262, U10 HL110338, U10 HL110312, U10 HL110302, U10 HL110336, and U10 HL110337. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Dr. Patel is supported by NHLBI T32 postdoctoral training grant T32HL069771. Dr. Vaduganathan is supported by KL2/Catalyst Medical Research Investigator Training award, Harvard Catalyst, Harvard Clinical and Translational Science Center, National Center for Advancing Translational Sciences, NIH award KL2 TR002542; and serves on advisory boards for Bayer AG and Baxter Healthcare. Dr. Greene is supported by NHLBI T32 postdoctoral training grant T32HL069749-14 and Heart Failure Society of America/Emergency Medicine Foundation Acute Heart Failure Young Investigator Award, Novartis; and has received research support from Amgen and Novartis. Dr. Felker has received research support from NHLBI, the American Heart Association, Novartis, Cytokinetics, Amgen, and Merck; and has consulted for Amgen, Novartis, Bristol-Myers Squibb, Stealth, SC Pharma, Innolife, Cytokinetics, VWave, EBR Systems, and Cardionomic. Dr. Butler has received research support from NIH and European Union; and has consulted for Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, CVRx, Janssen, Luitpold Pharmaceuticals, Medtronic, Merck, Novartis, Relypsa, Vifor Pharma, and ZS Pharma. Dr. Shah has received research grants from Actelion, AstraZeneca, Corvia, and Novartis; and is a compensated consultant for Actelion, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Cardiora, Eisai, Ironwood, Merck, Novartis, Sanofi, and United Therapeutics. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Publisher Copyright:
© 2019 American College of Cardiology Foundation
PY - 2019/1
Y1 - 2019/1
N2 - Objectives: This study sought to characterize the course of decongestion among patients hospitalized for acute heart failure (AHF) by history of atrial fibrillation (AF) and/or atrial flutter (AFL). Background: AF/AFL and chronic heart failure (HF) commonly coexist. Little is known regarding the impact of AF/AFL on relief of congestion among patients who develop AHF. Methods: We pooled patients from 3 randomized trials of AHF conducted within the Heart Failure Network, the DOSE (Diuretic Optimization Strategies) trial, the ROSE (Renal Optimization Strategies) trial, and the CARRESS-HF (Cardiorenal Rescue Study in Acute Decompensated Heart Failure) trial. The association between history of AF/AFL and in-hospital changes in various metrics of congestion was assessed using covariate-adjusted linear and ordinal logistic regression models. Results: Of 750 unique patients, 418 (56%) had a history of AF/AFL. Left ventricular ejection fraction was higher (35% vs. 27%, respectively; p < 0.001), and N-terminal pro–brain natriuretic peptide (NT-proBNP) levels were nonsignificantly lower at baseline (4,210 pg/ml vs. 5,037 pg/ml, respectively; p = 0.27) in patients with AF/AFL. After adjustment of covariates, history of AF/AFL was associated with less substantial loss of weight (−5.7% vs. −6.5%, respectively; p = 0.02) and decrease in NT-proBNP levels (−18.7% vs. −31.3%, respectively; p = 0.003) by 72 or 96 h. History of AF/AFL was also associated with a blunted increase in global sense of well being at 72 or 96 h (p = 0.04). There was no association between history of AF/AFL and change in orthodema congestion score (p = 0.67) or 60-day composite clinical endpoint (all-cause mortality or any rehospitalization; hazard ratio: 1.21; 95% confidence interval: 0.92 to 1.59; p = 0.17). Conclusions: More than half of the patients admitted with AHF had a history of AF/AFL. History of AF/AFL was independently associated with a blunted course of in-hospital decongestion. Further research is required to understand the utility of specific therapies targeting AF/AFL during hospitalization for AHF.
AB - Objectives: This study sought to characterize the course of decongestion among patients hospitalized for acute heart failure (AHF) by history of atrial fibrillation (AF) and/or atrial flutter (AFL). Background: AF/AFL and chronic heart failure (HF) commonly coexist. Little is known regarding the impact of AF/AFL on relief of congestion among patients who develop AHF. Methods: We pooled patients from 3 randomized trials of AHF conducted within the Heart Failure Network, the DOSE (Diuretic Optimization Strategies) trial, the ROSE (Renal Optimization Strategies) trial, and the CARRESS-HF (Cardiorenal Rescue Study in Acute Decompensated Heart Failure) trial. The association between history of AF/AFL and in-hospital changes in various metrics of congestion was assessed using covariate-adjusted linear and ordinal logistic regression models. Results: Of 750 unique patients, 418 (56%) had a history of AF/AFL. Left ventricular ejection fraction was higher (35% vs. 27%, respectively; p < 0.001), and N-terminal pro–brain natriuretic peptide (NT-proBNP) levels were nonsignificantly lower at baseline (4,210 pg/ml vs. 5,037 pg/ml, respectively; p = 0.27) in patients with AF/AFL. After adjustment of covariates, history of AF/AFL was associated with less substantial loss of weight (−5.7% vs. −6.5%, respectively; p = 0.02) and decrease in NT-proBNP levels (−18.7% vs. −31.3%, respectively; p = 0.003) by 72 or 96 h. History of AF/AFL was also associated with a blunted increase in global sense of well being at 72 or 96 h (p = 0.04). There was no association between history of AF/AFL and change in orthodema congestion score (p = 0.67) or 60-day composite clinical endpoint (all-cause mortality or any rehospitalization; hazard ratio: 1.21; 95% confidence interval: 0.92 to 1.59; p = 0.17). Conclusions: More than half of the patients admitted with AHF had a history of AF/AFL. History of AF/AFL was independently associated with a blunted course of in-hospital decongestion. Further research is required to understand the utility of specific therapies targeting AF/AFL during hospitalization for AHF.
KW - atrial fibrillation
KW - atrial flutter
KW - body weight
KW - decongestion
KW - heart failure
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U2 - 10.1016/j.jchf.2018.09.008
DO - 10.1016/j.jchf.2018.09.008
M3 - Article
C2 - 30409707
AN - SCOPUS:85059495453
VL - 7
SP - 47
EP - 55
JO - JACC: Heart Failure
JF - JACC: Heart Failure
SN - 2213-1779
IS - 1
ER -