Left Ventricular Systolic Dysfunction, Heart Failure, and the Risk of Stroke and Systemic Embolism in Patients With Atrial Fibrillation: Insights From the ARISTOTLE Trial

McMurray, J.J.V. et al. (2013) Left Ventricular Systolic Dysfunction, Heart Failure, and the Risk of Stroke and Systemic Embolism in Patients With Atrial Fibrillation: Insights From the ARISTOTLE Trial. Circulation: Heart Failure, 6(3), pp. 451-460. (doi:10.1161/CIRCHEARTFAILURE.112.000143)

Full text not currently available from Enlighten.

Abstract

Background—We examined the risk of stroke or systemic embolism (SSE) conferred by heart failure (HF) and left ventricular systolic dysfunction (LVSD) in the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation Trial (ARISTOTLE), as well as the effect of apixaban versus warfarin.

Methods and Results—The risk of a number of outcomes, including the composite of SSE or death (to take account of competing risks) and composite of SSE, major bleeding, or death (net clinical benefit) were calculated in 3 patient groups: (1) no HF/no LVSD (n=8728), (2) HF/no LVSD (n=3207), and (3) LVSD with/without symptomatic HF (n=2736). The rate of both outcomes was highest in patients with LVSD (SSE or death 8.06; SSE, major bleeding, or death 10.46 per 100 patient-years), intermediate for HF but preserved LV systolic function (5.32; 7.24), and lowest in patients without HF or LVSD (1.54; 5.27); each comparison P<0.0001. Each outcome was less frequent in patients treated with apixaban: in all ARISTOTLE patients, the apixaban/warfarin hazard ratio for SSE or death was 0.89 (95% confidence interval, 0.81–0.98; P=0.02); for SSE, major bleed, or death it was 0.85 (0.78–0.92; P<0.001). There was no heterogeneity of treatment effect across the 3 groups.

Conclusions—Patients with LVSD (with/without HF) had a higher risk of SSE or death (but similar rate of SSE) compared with patients with HF but preserved LV systolic function; both had a greater risk than patients without either HF or LVSD. Apixaban reduced the risk of both outcomes more than warfarin in all 3 patient groups.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:McMurray, Professor John
Authors: McMurray, J.J.V., Ezekowitz, J.A., Lewis, B.S., Gersh, B.J., van Diepen, S., Amerena, J., Bartunek, J., Commerford, P., Oh, B.-H., Harjola, V.-P., Al-Khatib, S.M., Hanna, M., Alexander, J.H., Lopes, R.D., Wojdyla, D.M., Wallentin, L., and Granger, C.B.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
Journal Name:Circulation: Heart Failure
Publisher:Lippincott Williams and Wilkins
ISSN:1941-3289
ISSN (Online):1941-3297

University Staff: Request a correction | Enlighten Editors: Update this record