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Manito N, Cepeda‐Rodrigo JM, Farré N, Castillo Orive M, Galve E, Jiménez‐Candil J, García‐Pinilla JM, López Sánchez ES, Rafols C, Gómez Doblas JJ. Factors associated with disease progression in patients with atrial fibrillation and heart failure anticoagulated with rivaroxaban. Clin Cardiol 2024; 47:e24189. [PMID: 38018889 PMCID: PMC10823448 DOI: 10.1002/clc.24189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 10/09/2023] [Accepted: 10/30/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Patients with atrial fibrillation (AF) and heart failure (HF) have a high risk of thromboembolism and other outcomes and anticoagulation is recommended. HYPOTHESIS This study was aimed to explore the risk factors associated with HF worsening in patients with AF and HF taking rivaroxaban in Spain. METHODS Multicenter, prospective, observational study that included adults with AF and chronic HF, receiving rivaroxaban ≥4 months before entering. HF worsening was defined as first hospitalization or emergency visit because of HF exacerbation. RESULTS A total of 672 patients from 71 Spanish centers were recruited, of whom 658 (97.9%) were included in the safety analysis and 552 (82.1%) in the per protocol analysis. At baseline, mean age was 73.7 ± 10.9 years, 64.9% were male, CHA2 DS2 -VASc was 4.1 ± 1.5, HAS-BLED was 1.6 ± 0.9% and 51.3% had HF with preserved ejection fraction. After 24 months of follow-up, 24.9% of patients developed HF worsening, 11.6% died, 2.9% had a thromboembolic event, 3.1% a major bleeding, 0.5% an intracranial bleeding and no patient had a fatal hemorrhage. Older age, the history of chronic obstructive pulmonary disease, the previous use of vitamin K antagonists, and restrictive or infiltrative cardiomyopathies, were independently associated with HF worsening. Only 6.9% of patients permanently discontinued rivaroxaban treatment. CONCLUSIONS Approximately one out of four patients with HF and AF treated with rivaroxaban developed a HF worsening episode after 2 years of follow-up. The identification of those factors that increase the risk of HF worsening could be helpful in the comprehensive management of this population.
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Affiliation(s)
- Nicolás Manito
- Cardiology DepartmentHospital Universitario de BellvitgeBarcelonaSpain
| | | | - Nuria Farré
- Cardiology DepartmentHospital del MarBarcelonaSpain
| | | | | | - Javier Jiménez‐Candil
- Cardiology DepartmentIBSAL‐Hospital Universitario de Salamanca, Universidad de Salamanca, CIBER‐CVSalamancaSpain
| | - José M. García‐Pinilla
- Cardiology DepartmentHospital Universitario Virgen de la VictoriaMálagaSpain
- Instituto de Investigación Biomédica de Málaga‐Plataforma BIONANDMálagaSpain
- Ciber‐CardiovascularInstituto de Salud Carlos IIIMadridSpain
- Department of Medicine and DermatologyUniversidad de MálagaMálagaSpain
| | | | | | - Juan José Gómez Doblas
- Cardiology DepartmentHospital Universitario Virgen de la VictoriaMálagaSpain
- Instituto de Investigación Biomédica de Málaga‐Plataforma BIONANDMálagaSpain
- Ciber‐CardiovascularInstituto de Salud Carlos IIIMadridSpain
- Department of Medicine and DermatologyUniversidad de MálagaMálagaSpain
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2
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Gómez Doblas JJ, Cepeda‐Rodrigo JM, Agra Bermejo R, Blanco Labrador E, Blasco MT, Carrera Izquierdo M, Lekuona I, Recio Mayoral A, Rafols C, Manito N. Outcomes and factors associated with mortality in patients with atrial fibrillation and heart failure: FARAONIC study. Clin Cardiol 2023; 46:1390-1397. [PMID: 37596723 PMCID: PMC10642327 DOI: 10.1002/clc.24106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 07/14/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND Heart failure (HF) and atrial fibrillation (AF) are common and coexistent conditions. HYPOTHESIS To investigate the adverse events and mortality risk factors in patients with AF and HF treated with rivaroxaban in Spain. METHODS Multicenter, prospective and observational study with a follow-up of 2 years, that included adults, with a diagnosis of nonvalvular AF and chronic HF, anticoagulated with rivaroxaban at least 4 months before being enrolled. RESULTS A total of 672 patients from 71 Spanish centers were recruited, of whom 658 (97.9%) were included in the safety analysis and 552 (82.1%) in the per protocol analysis. At baseline, the mean age was 73.7 ± 10.9 years, 65.9% were male, 51.3% had HF with preserved ejection fraction and 58.7% were on New York Heart Association functional class II. CHA2 DS2 -VASc was 4.1 ± 1.5. During the follow-up, 11.6% of patients died and around one-quarter of patients were hospitalized or visited the emergency department, being HF worsening/progression the main cause (51.1%), with a 2.9% of thromboembolic events and 2.0% of acute coronary syndromes. Major bleeding occurred in 3.1% of patients, with 0.5% experiencing intracranial bleeding but no fatalities. Compliance with HF treatment was associated with a lower risk of death (hazard ratio: 0.092; 95% confidence interval: 0.03-0.31). CONCLUSIONS Among patients with HF and AF anticoagulated with rivaroxaban, incidences of thromboembolic or hemorrhagic complications were low. The most important factor for improving survival was compliance with HF drugs, what strengths the need for early treatment with HF disease-modifying therapy and anticoagulation.
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Affiliation(s)
- Juan José Gómez Doblas
- Cardiology DepartmentHospital Clínico Universitario Virgen de la VictoriaMálagaSpain
- Centro de Investigación Biomédica en Red de Enfermedades CardiovascularesCIBERCVMadridSpain
| | | | - Rosa Agra Bermejo
- Cardiology DepartmentHospital Universitario de Santiago de CompostelaA CoruñaSpain
| | | | | | | | - Iñaki Lekuona
- Cardiology DepartmentHospital Galdakao‐UsansoloBizkaiaSpain
| | | | | | - Nicolás Manito
- Cardiology DepartmentHospital Universitario de BellvitgeBarcelonaSpain
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3
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Hewage SA, Noviyani R, Brain D, Sharma P, Parsonage W, McPhail SM, Barnett A, Kularatna S. Cost-effectiveness of left atrial appendage closure for stroke prevention in atrial fibrillation: a systematic review appraising the methodological quality. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2023; 21:76. [PMID: 37872572 PMCID: PMC10591401 DOI: 10.1186/s12962-023-00486-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 10/10/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND The increasing global prevalence of atrial fibrillation (AF) has led to a growing demand for stroke prevention strategies, resulting in higher healthcare costs. High-quality economic evaluations of stroke prevention strategies can play a crucial role in maximising efficient allocation of resources. In this systematic review, we assessed the methodological quality of such economic evaluations. METHODS We searched electronic databases of PubMed, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, and Econ Lit to identify model-based economic evaluations comparing the left atrial appendage closure procedure (LAAC) and oral anticoagulants published in English since 2000. Data on study characteristics, model-based details, and analyses were collected. The methodological quality was evaluated using the modified Economic Evaluations Bias (ECOBIAS) checklist. For each of the 22 biases listed in this checklist, studies were categorised into one of four groups: low risk, partial risk, high risk due to inadequate reporting, or high risk. To gauge the overall quality of each study, we computed a composite score by assigning + 2, 0, - 1 and - 2 to each risk category, respectively. RESULTS In our analysis of 12 studies, majority adopted a healthcare provider or payer perspective and employed Markov Models with the number of health states varying from 6 to 16. Cost-effectiveness results varied across studies. LAAC displayed a probability exceeding 50% of being the cost-effective option in six out of nine evaluations compared to warfarin, six out of eight evaluations when compared to dabigatran, in three out of five evaluations against apixaban, and in two out of three studies compared to rivaroxaban. The methodological quality scores for individual studies ranged from 10 to - 12 out of a possible 24. Most high-risk ratings were due to inadequate reporting, which was prevalent across various biases, including those related to data identification, baseline data, treatment effects, and data incorporation. Cost measurement omission bias and inefficient comparator bias were also common. CONCLUSIONS While most studies concluded LAAC to be the cost-effective strategy for stroke prevention in AF, shortcomings in methodological quality raise concerns about reliability and validity of results. Future evaluations, free of these shortcomings, can yield stronger policy evidence.
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Affiliation(s)
- Sumudu A Hewage
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, Queensland University of Technology, No.61, Musk Avenue, Kelvin Grove, QLD, 4059, Australia.
| | - Rini Noviyani
- Department of Pharmacy, Udayana University, Bali, Indonesia
| | - David Brain
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, Queensland University of Technology, No.61, Musk Avenue, Kelvin Grove, QLD, 4059, Australia
| | - Pakhi Sharma
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, Queensland University of Technology, No.61, Musk Avenue, Kelvin Grove, QLD, 4059, Australia
| | - William Parsonage
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, Queensland University of Technology, No.61, Musk Avenue, Kelvin Grove, QLD, 4059, Australia
- Cardiology department, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Steven M McPhail
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, Queensland University of Technology, No.61, Musk Avenue, Kelvin Grove, QLD, 4059, Australia
- Digital Health and Informatics Directorate, Metro South Health, Brisbane, QLD, Australia
| | - Adrian Barnett
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, Queensland University of Technology, No.61, Musk Avenue, Kelvin Grove, QLD, 4059, Australia
| | - Sanjeewa Kularatna
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, Queensland University of Technology, No.61, Musk Avenue, Kelvin Grove, QLD, 4059, Australia
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4
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Schnabel RB, Ameri P, Siller-Matula JM, Diemberger I, Gwechenberger M, Pecen L, Manu MC, Souza J, De Caterina R, Kirchhof P. Outcomes of patients with atrial fibrillation on oral anticoagulation with and without heart failure: the ETNA-AF-Europe registry. Europace 2023; 25:euad280. [PMID: 37713182 PMCID: PMC10540669 DOI: 10.1093/europace/euad280] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 09/07/2023] [Accepted: 09/09/2023] [Indexed: 09/16/2023] Open
Abstract
AIMS Heart failure (HF) is a risk factor for major adverse events in atrial fibrillation (AF). Whether this risk persists on non-vitamin K antagonist oral anticoagulants (NOACs) and varies according to left ventricular ejection fraction (LVEF) is debated. METHODS AND RESULTS We investigated the relation of HF in the ETNA-AF-Europe registry, a prospective, multicentre, observational study with an overall 4-year follow-up of edoxaban-treated AF patients. We report 2-year follow-up for ischaemic stroke/transient ischaemic attack (TIA)/systemic embolic events (SEE), major bleeding, and mortality. Of the 13 133 patients, 1854 (14.1%) had HF. Left ventricular ejection fraction was available for 82.4% of HF patients and was <40% in 671 (43.9%) and ≥40% in 857 (56.1%). Patients with HF were older, more often men, and had more comorbidities. Annualized event rates (AnERs) of any stroke/SEE were 0.86%/year and 0.67%/year in patients with and without HF. Compared with patients without HF, those with HF also had higher AnERs for major bleeding (1.73%/year vs. 0.86%/year) and all-cause death (8.30%/year vs. 3.17%/year). Multivariate Cox proportional models confirmed HF as a significant predictor of major bleeding [hazard ratio (HR) 1.65, 95% confidence interval (CI): 1.20-2.26] and all-cause death [HF with LVEF <40% (HR 2.42, 95% CI: 1.95-3.00) and HF with LVEF ≥40% (HR 1.80, 95% CI: 1.45-2.23)] but not of ischaemic stroke/TIA/SEE. CONCLUSION Anticoagulated patients with HF at baseline featured higher rates of major bleeding and all-cause death, requiring optimized management and novel preventive strategies. NOAC treatment was similarly effective in reducing risk of ischaemic events in patients with or without concomitant HF.
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Affiliation(s)
- Renate B Schnabel
- Department of Cardiology, University Clinic Hamburg-Eppendorf, University Heart and Vascular Centre Hamburg-Eppendorf, Buildung O50, Martinistrasse 52, 20246 Hamburg, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck, Potsdamer Str, 5810785 Berlin, Germany
| | - Pietro Ameri
- Department of Internal Medicine, University of Genova, Genova, Italy
- Cardiac, Thoracic and Vascular Department, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | | | - Igor Diemberger
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
- Unit of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | | | - Ladislav Pecen
- Czech Academy of Science, Institute of Computer Sciences, Prague, Czech Republic
- Department of Immunochemistry Diagnostics, University Hospital Pilsen, Pilsen, Czech Republic
| | | | - José Souza
- Daiichi Sankyo Europe GmbH, Munich, Germany
| | - Raffaele De Caterina
- Cardiology Division, Pisa University Hospital, Pisa, Italy
- Fondazione Villa Serena per la Ricerca, Pescara, Italy
| | - Paulus Kirchhof
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- Department of Cardiology, University Heart and Vascular Centre Hamburg, University Medical Centre Hamburg Eppendorf, Hamburg, Germany
- German Center for Cardiovascular Sciences (DZHK), partner site Hamburg/Kiel/Lübeck, Germany
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5
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Sánchez MA, Marín F, Masjuan J, Cosín-Sales J, Rodríguez JMV, Barrios V, Barón-Esquivias G, Lekuona I, Pérez-Cabeza AI, Freixa-Pamias R, Jimenez FJP, Khatib MMK, Priu CR, Fernández MS. Impact of heart failure on the clinical profile and outcomes in patients with atrial fibrillation treated with rivaroxaban. Data from the EMIR study. Cardiol J 2022; 29:936-947. [PMID: 36200548 PMCID: PMC9788750 DOI: 10.5603/cj.a2022.0091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 08/01/2022] [Accepted: 09/04/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The aim of this study was to analyze the impact of the presence of heart failure (HF) on the clinical profile and outcomes in patients with atrial fibrillation (AF) anticoagulated with rivaroxaban. METHODS Observational and non-interventional study that included AF adults recruited from 79 Spanish centers, anticoagulated with rivaroxaban ≥ 6 months before inclusion. Data were analyzed according to baseline HF status. RESULTS Out of 1,433 patients, 326 (22.7%) had HF at baseline. Compared to patients without HF, HF patients were older (75.3 ± 9.9 vs. 73.8 ± 9.6 years; p = 0.01), had more diabetes (36.5% vs. 24.3%; p < 0.01), coronary artery disease (28.2% vs. 12.9%; p < 0.01), renal insufficiency (31.7% vs. 22.6%; p = 0.01), higher CHA2DS2-VASc (4.5 ± 1.6 vs. 3.2 ± 1.4; p < 0.01) and HAS-BLED (1.8 ± 1.1 vs. 1.5 ± 1.0; p < 0.01). After a median follow-up of 2.5 years, among HF patients, annual rates of stroke/systemic embolism/transient ischemic attack, major adverse cardiovascular events (MACE) (non-fatal myocardial infarction, revascularization and cardiovascular death), cardiovascular death, and major bleeding were 1.2%, 3.0%, 2.0%, and 1.4%, respectively. Compared to those patients without HF, HF patients had greater annual rates of MACE (3.0% vs. 0.5%; p < 0.01) and cardiovascular death (2.0% vs. 0.2%; p < 0.01), without significant differences regarding other outcomes, including thromboembolic or bleeding events. Previous HF was an independent predictor of MACE (odds ratio 3.4; 95% confidence interval 1.6-7.3; p = 0.002) but not for thromboembolic events or major bleeding. CONCLUSIONS Among AF patients anticoagulated with rivaroxaban, HF patients had a worse clinical profile and a higher MACE risk and cardiovascular mortality. HF was independently associated with the development of MACE, but not with thromboembolic events or major bleeding.
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Affiliation(s)
- Manuel Anguita Sánchez
- Department of Cardiology, Hospital Reina Sofía Córdoba, IMIBIC, University of Cordoba, Spain
| | - Francisco Marín
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, University of Murcia, CIBERCV, Murcia, Spain
| | - Jaime Masjuan
- Servicio de Neurología, Hospital Universitario Ramón y Cajal, IRYCIS, Departamento de Medicina, Universidad de Alcalá. Red INVICTUS, Madrid, Spain
| | - Juan Cosín-Sales
- Department of Cardiology, Hospital Arnau de Vilanova, Valencia, Spain
| | | | - Vivencio Barrios
- Department of Cardiology, University Hospital Ramón y Cajal, Madrid, Alcalá University, Madrid, Spain
| | - Gonzalo Barón-Esquivias
- Department of Cardiology, Hospital Universitario Virgen del Rocio, Universidad de Sevilla, Sevilla, Spain,Unidad Cardiovascular, Instituto de Biotecnología de Sevilla, Centro de Investigación en Red Cardiovascular, Madrid, Spain
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6
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Gawałko M, Budnik M, Gorczyca I, Jelonek O, Uziębło-Życzkowska B, Maciorowska M, Wójcik M, Błaszczyk R, Tokarek T, Rajtar-Salwa R, Bil J, Wojewódzki M, Szpotowicz A, Krzciuk M, Bednarski J, Bakuła-Ostalska E, Tomaszuk-Kazberuk A, Szyszkowska A, Wełnicki M, Mamcarz A, Kapłon-Cieślicka A. Characteristics and Treatment of Atrial Fibrillation with Respect to the Presence or Absence of Heart Failure. Insights from the Multicenter Polish Atrial Fibrillation (POL-AF) Registry. J Clin Med 2021; 10:jcm10071341. [PMID: 33804992 PMCID: PMC8036873 DOI: 10.3390/jcm10071341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 03/22/2021] [Accepted: 03/22/2021] [Indexed: 12/15/2022] Open
Abstract
Background: We aimed to assess characteristics and treatment of AF patients with and without heart failure (HF). Methods: The prospective, observational Polish Atrial Fibrillation (POL-AF) Registry included consecutive patients with AF hospitalized in 10 Polish cardiology centers in 2019–2020. Results: Among 3999 AF patients, 2822 (71%) had HF (AF/HF group). Half of AF/HF patients had preserved ejection fraction (HFpEF). Compared to patients without HF (AF/non–HF), AF/HF patients were older, more often male, more often had permanent AF, and had more comorbidities. Of AF/HF patients, 98% had class I indications to oral anticoagulation (OAC). Still, 16% of patients were not treated with OAC at hospital admission, and 9%—at discharge (regardless of the presence of HF and its subtypes). Of patients not receiving OAC upon admission, 61% were prescribed OAC (most often apixaban) at discharge. AF/non–HF patients more often converted from AF at admission to sinus rhythm at discharge compared to AF/HF patients (55% vs. 30%), despite cardioversion performed as often in both groups. Class I antiarrhythmics were more often prescribed in AF/non–HF than in AF/HF group (13% vs. 8%), but still as many as 15% of HFpEF patients received them. Conclusions: Over 70% of hospitalized AF patients have coexisting HF. A significant number of AF patients does not receive the recommended OAC.
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Affiliation(s)
- Monika Gawałko
- 1st Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland; (M.G.); (M.B.)
| | - Monika Budnik
- 1st Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland; (M.G.); (M.B.)
| | - Iwona Gorczyca
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, 25-736 Kielce, Poland; (I.G.); (O.J.)
- Collegium Medicum, The Jan Kochanowski University, 25-369 Kielce, Poland
| | - Olga Jelonek
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, 25-736 Kielce, Poland; (I.G.); (O.J.)
- Collegium Medicum, The Jan Kochanowski University, 25-369 Kielce, Poland
| | - Beata Uziębło-Życzkowska
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, 04-141 Warsaw, Poland; (B.U.-Ż.); (M.M.)
| | - Małgorzata Maciorowska
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, 04-141 Warsaw, Poland; (B.U.-Ż.); (M.M.)
| | - Maciej Wójcik
- Department of Cardiology, Medical University of Lublin, 20-059 Lublin, Poland; (M.W.); (R.B.)
| | - Robert Błaszczyk
- Department of Cardiology, Medical University of Lublin, 20-059 Lublin, Poland; (M.W.); (R.B.)
| | - Tomasz Tokarek
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 30-688 Kraków, Poland; (T.T.); (R.R.-S.)
| | - Renata Rajtar-Salwa
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 30-688 Kraków, Poland; (T.T.); (R.R.-S.)
| | - Jacek Bil
- Department of Invasive Cardiology, Centre of Postgraduate Medical Education, 02-507 Warsaw, Poland; (J.B.); (M.W.)
| | - Michał Wojewódzki
- Department of Invasive Cardiology, Centre of Postgraduate Medical Education, 02-507 Warsaw, Poland; (J.B.); (M.W.)
| | - Anna Szpotowicz
- Department of Cardiology, Regional Hospital, 27-400 Ostrowiec Świętokrzyski, Poland; (A.S.); (M.K.)
| | - Małgorzata Krzciuk
- Department of Cardiology, Regional Hospital, 27-400 Ostrowiec Świętokrzyski, Poland; (A.S.); (M.K.)
| | - Janusz Bednarski
- Department of Cardiology, St John Paul’s II Western Hospital, 05-825 Grodzisk Mazowiecki, Poland; (J.B.); (E.B.-O.)
| | - Elwira Bakuła-Ostalska
- Department of Cardiology, St John Paul’s II Western Hospital, 05-825 Grodzisk Mazowiecki, Poland; (J.B.); (E.B.-O.)
| | - Anna Tomaszuk-Kazberuk
- Department of Cardiology, University Hospital of Białystok, 15-276 Białystok, Poland; (A.T.-K.); (A.S.)
| | - Anna Szyszkowska
- Department of Cardiology, University Hospital of Białystok, 15-276 Białystok, Poland; (A.T.-K.); (A.S.)
| | - Marcin Wełnicki
- 3rd Department of Internal Diseases and Cardiology, Warsaw Medical University, 02-091 Warsaw, Poland; (M.W.); (A.M.)
| | - Artur Mamcarz
- 3rd Department of Internal Diseases and Cardiology, Warsaw Medical University, 02-091 Warsaw, Poland; (M.W.); (A.M.)
| | - Agnieszka Kapłon-Cieślicka
- 1st Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland; (M.G.); (M.B.)
- Correspondence: ; Tel.: +48-22-599-29-58
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7
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Dubner SJ, Teutsch C, Huisman MV, Diener HC, Halperin J, Rothman KJ, Ma CS, Chuquiure-Valenzuela E, Bergler-Klein J, Zint K, Riou França L, Lu S, Paquette M, Lip GYH. Characteristics and 2-year outcomes of dabigatran treatment in patients with heart failure and atrial fibrillation: GLORIA-AF. ESC Heart Fail 2020; 7:2679-2689. [PMID: 32613745 PMCID: PMC7524082 DOI: 10.1002/ehf2.12857] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 05/06/2020] [Accepted: 06/03/2020] [Indexed: 01/10/2023] Open
Abstract
Aims This study aimed to describe baseline characteristics of patients with atrial fibrillation (AF) at risk of stroke with and without history of heart failure (HF) and report 2‐year outcomes in the dabigatran‐treated subset of a prospective, global, observational study (GLORIA‐AF). Methods and results Newly diagnosed patients with AF and CHA2DS2‐VASc score ≥ 1 were consecutively enrolled. Baseline characteristics were assessed by the presence or absence of HF diagnosis at enrolment. Incidence rates for outcomes in dabigatran‐treated patients were estimated with and without standardization by stroke (excluding HF component) and bleeding risk scores. A total of 15 308 eligible patients were enrolled, including 15 154 with known HF status; of these, 3679 (24.0%) had been diagnosed with HF, 11 475 (75.0%) had not. Among 4873 dabigatran‐treated patients, 1169 (24.0%) had HF, and 3658 (75.1%) did not; the risk of stroke was high (CHA2DS2‐VASc score ≥ 2) for 94.3% of patients with HF and 85.8% without, while 6.0% and 7.0%, respectively, had a high bleeding risk (HAS‐BLED ≥ 3). Incidence rates of all‐cause death in dabigatran‐treated patients with and without HF, standardized for CHA2DS2‐VASc and HAS‐BLED scores, were 4.76 vs. 1.80 per 100 patient years (py), with roughly comparable rates of stroke (0.82 vs. 0.60 per 100 py) and major bleeding (1.20 vs. 0.92 per 100 py). Conclusions Patients with AF and history of HF may have greater disease burden at AF diagnosis and increased mortality rates vs. patients without HF. Stroke and major bleeding rates were roughly comparable between groups confirming the long‐term safety and effectiveness of dabigatran in patients with HF.
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Affiliation(s)
- Sergio J Dubner
- Clínica y Maternidad Suizo Argentina, Buenos Aires, Argentina
| | | | | | | | | | - Kenneth J Rothman
- RTI Health Solutions, Research Triangle Institute, Research Triangle Park, NC, USA
| | - Chang-Sheng Ma
- Atrial Fibrillation Center, Beijing Anzhen Hospital, Beijing, People's Republic of China
| | | | - Jutta Bergler-Klein
- Department of Cardiology, University Clinic of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Kristina Zint
- Boehringer Ingelheim International GmbH, Ingelheim, Germany
| | | | - Shihai Lu
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, USA
| | | | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Clinical Medicine, Aalborg Thrombosis Research Unit, Aalborg University, Aalborg, Denmark
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