A history of atrial fibrillation and outcomes in chronic advanced systolic heart failure: a propensity-matched study.
Pubmed ID: 19531579
Pubmed Central ID: PMC2726959
Journal: European heart journal
Publication Date: 08/01/2009
Affiliation: University of Alabama at Birmingham, 1530 3rd Avenue South, CH-19, Ste-219, Birmingham, AL 35294-2041, USA.
MeSH Terms: Humans, Male, Female, Aged, Middle Aged, Adrenergic beta-Antagonists, Atrial Fibrillation, Chronic Disease, Heart Failure, Hospitalization, Propensity Score, Regression Analysis, Treatment Outcome
Grants: K23 AG019211, K23 AG019211-03, R01 HL085561, R01-HL085561
Authors: Ahmed MI, White M, Ekundayo OJ, Love TE, Aban I, Liu B, Aronow WS, Ahmed A
Cite As: Ahmed MI, White M, Ekundayo OJ, Love TE, Aban I, Liu B, Aronow WS, Ahmed A. A history of atrial fibrillation and outcomes in chronic advanced systolic heart failure: a propensity-matched study. Eur Heart J 2009 Aug;30(16):2029-37. Epub 2009 Jun 16.
- Beta-Blocker Evaluation in Survival Trial (BEST)
- Systolic Blood Pressure Intervention Trial (SPRINT)
- Systolic Blood Pressure Intervention Trial Primary Outcome Paper (SPRINT-POP) Data
AIMS: Atrial fibrillation (AF)-associated poor outcomes in heart failure (HF) are often attributed to older age, advanced disease, and comorbidity burden of HF patients with AF. Therefore, we examined the effect of AF on outcomes in a propensity-matched study in which patients with and without AF were well balanced on all measured baseline characteristics. METHODS AND RESULTS: Of the 2708 advanced chronic systolic HF patients in the Beta-Blocker Evaluation of Survival Trial, 653 had a history of AF. Propensity scores for AF were calculated for each patient and were used to assemble a cohort of 487 pairs of patients with and without AF who were balanced on 74 baseline characteristics. Matched Cox regression analyses were used to estimate associations of AF with outcomes during 23 months of mean follow-up. All-cause mortality occurred in 187 (rate, 2046/10,000 person-years of follow-up) and 181 (rate, 1885/10,000 person-years) matched patients with and without AF, respectively [matched hazard ratio (HR) when AF was compared with no-AF 1.03, 95% confidence interval (CI) 0.79-1.33; P = 0.84]. Heart failure hospitalization occurred in 215 (rate, 3171/10,000 person-years) and 184 (rate, 2405/10,000 person-years) matched patients with and without AF, respectively (matched HR when AF was compared with no-AF 1.28, 95% CI 1.00-1.63; P = 0.049). Hazard ratios and 95% CIs for AF-associated HF hospitalization for bucindolol and placebo groups were, respectively, 1.08 (0.81-1.43) and 1.54 (1.17-2.03; P for interaction = 0.09). CONCLUSION: A history of AF had no intrinsic association with mortality but was associated with HF hospitalization in chronic systolic HF.