Acute heart failure and atrial fibrillation: insights from the acute study of clinical effectiveness of nesiritide in decompensated heart failure (ASCEND‐HF) trial

Abualnaja, S., Podder, M., Hernandez, A. F., McMurray, J. J. V. , Starling, R. C., O'Connor, C. M., Califf, R. M., Armstrong, P. W. and Ezekowitz, J. A. (2015) Acute heart failure and atrial fibrillation: insights from the acute study of clinical effectiveness of nesiritide in decompensated heart failure (ASCEND‐HF) trial. Journal of the American Heart Association, 4(8), e002092. (doi:10.1161/JAHA.115.002092) (PMID:26304935) (PMCID:PMC4599466)

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Abstract

Background: Patients with acute heart failure (AHF) frequently have atrial fibrillation (AF), but how this affects patient-reported outcomes has not been well characterized. Methods and Results: We examined dyspnea improvement and clinical outcomes in 7007 patients in the Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure (ASCEND-HF) trial. At baseline, 2677 (38.2%) patients had current or a history of AF and 4330 (61.8%) did not. Patients with a history of AF were older than those without (72 vs. 63 years) and had more comorbidities and a higher median left ventricular ejection fraction (31% vs. 27%, P>0.001). Compared to those without AF, patients with AF had a similar mean ventricular rate on admission (81 vs. 83 beats per minute [bpm]; P=0.138) but a lower rate at discharge (75 vs. 78 bpm; P>0.001). There was no difference in dyspnea improvement between patients with and without AF at 6 hours (P=0.087), but patients with AF had less dyspnea improvement at 24 hours (P>0.001). Compared to patients without AF, patients with AF had a higher 30-day all-cause mortality rate (4.7% vs. 3.3%; P=0.005), a higher 30-day HF rehospitalisation rate (7.2% vs. 5.3%; P=0.001), and a higher coprimary composite outcome of 30-day death or readmission (11.6% vs. 8.6%; P>0.001). This difference persisted after adjustment for prognostic variables (adjusted odds ratio=1.19; (95% confidence interval, 1.02 to 1.38; P=0.029). Conclusions: Among patients admitted to the hospital with AHF, current or a history of AF is associated with less dyspnea improvement and higher morbidity and mortality at 30-days, compared to those not in AF.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:McMurray, Professor John
Authors: Abualnaja, S., Podder, M., Hernandez, A. F., McMurray, J. J. V., Starling, R. C., O'Connor, C. M., Califf, R. M., Armstrong, P. W., and Ezekowitz, J. A.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
Journal Name:Journal of the American Heart Association
Publisher:Wiley Blackwell for the American Heart Association
ISSN:2047-9980
ISSN (Online):2047-9980
Copyright Holders:Copyright © 2015 The Authors
First Published:First published in Journal of the American Heart Association 4(8):e002092
Publisher Policy:Reproduced under a Creative Commons licence

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