Outcomes of patients with atrial fibrillation on oral anticoagulation with and without heart failure: the ETNA-AF-Europe registry

0576552 - ÚI 2024 RIV GB eng J - Článek v odborném periodiku
Schnabel, R. B. - Ameri, P. - Siller-Matula, J. M. - Diemberger, I. - Gwechenberger, M. - Pecen, Ladislav - Manu, M. C. - 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. Roč. 25, č. 9 (2023), č. článku euad280. ISSN 1099-5129. E-ISSN 1532-2092
Institucionální podpora: RVO:67985807
Klíčová slova: Atrial fibrillation * Edoxaban * Heart failure * Left ventricular ejection fraction * Non-vitamin K antagonist oral anticoagulant * Registry
Obor OECD: Cardiac and Cardiovascular systems
Impakt faktor: 6.1, rok: 2022
Způsob publikování: Open access
https://dx.doi.org/10.1093/europace/euad280

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.
Trvalý link: https://hdl.handle.net/11104/0346109