New-onset atrial fibrillation in patients with worsening heart failure and coronary artery disease: an analysis from the COMMANDER-HF trial

Ferreira, J. P., Cleland, J. G. , Lam, C. S.P., Anker, S. D., Mehra, M. R., van Veldhuisen, D. J., Byra, W. M., LaPolice, D. A., Greenberg, B. and Zannad, F. (2022) New-onset atrial fibrillation in patients with worsening heart failure and coronary artery disease: an analysis from the COMMANDER-HF trial. Clinical Research in Cardiology, 111(1), pp. 50-59. (doi: 10.1007/s00392-021-01891-2) (PMID:34128083)

Abstract

Background: Atrial fibrillation (AF) in the presence of heart failure (HF) is associated with poor outcomes including a high-risk of stroke and other thromboembolic events. Identifying patients without AF who are at high-risk of developing this arrhythmia has important clinical implications. Aims: To develop a risk score to identify HF patients at high risk of developing AF. Methods: The COMMANDER-HF trial enrolled 5022 patients with HF and a LVEF ≤ 40%, history of coronary artery disease, and absence of AF at baseline (confirmed with an electrocardiogram). Patients were randomized to either rivaroxaban (2.5 mg bid) or placebo. New-onset AF was confirmed by the investigator at study visits. Results 241 (4.8%) patients developed AF during the follow-up (median 21 months). Older age (≥ 65 years), LVEF < 35%, history of PCI or CABG, White race, SBP < 110 mmHg, and higher BMI (≥ 25 kg/m2) were independently associated with risk of new-onset AF, whereas the use of DAPT was associated with a lower risk of new-onset AF. We then built a risk score from these variables (with good accuracy C-index = 0.71) and calibration across observed and predicted tertiles of risk. New-onset AF events rates increased steeply by increasing tertiles of the risk-score. Compared to tertile 1, the risk of new-onset AF was 2.5-fold higher in tertile 2, and 6.3-fold higher in tertile 3. Rivaroxaban had no effect in reducing new-onset AF. In time-updated models, new-onset AF was associated with a higher risk of subsequent all-cause death: HR (95%CI) 1.38 (1.11–1.73). Conclusions: A well-calibrated risk-score identified patients at risk of new-onset AF in the COMMANDER-HF trial. Patients who developed AF had a higher risk of subsequent death.

• Item Type: Articles
• Additional Information: JF and FZ are supported by the RHU Fight-HF, a public grant overseen by the French National Research Agency (ANR) as part of the second “Investissements d’Avenir” program (reference: ANR-15-RHUS-0004), and by the French PIA project “Lorraine Université d’Excellence” (reference: ANR-15-IDEX-04-LUE). The COMMANDER-HF trial was supported by Janssen Research and Development.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Cleland, Professor John and Ferreira, Mr Joao Pedro
• Authors: Ferreira, J. P., Cleland, J. G., Lam, C. S.P., Anker, S. D., Mehra, M. R., van Veldhuisen, D. J., Byra, W. M., LaPolice, D. A., Greenberg, B., and Zannad, F.
• Subjects: R Medicine > R Medicine (General)
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre
• Journal Name: Clinical Research in Cardiology
• Publisher: Springer
• ISSN: 1861-0684
• ISSN (Online): 1861-0692
• Published Online: 14 June 2021
• Copyright Holders: Copyright © 2021 Springer-Verlag GmbH Germany, part of Springer Nature
• First Published: First published in Clinical Research in Cardiology 111(1): 50-59
• Publisher Policy: Reproduced in accordance with the publisher copyright policy