History of Atrial Fibrillation and Trajectory of Decongestion in Acute Heart Failure.
Acute Disease
Aged
Aged, 80 and over
Atrial Fibrillation
/ epidemiology
Atrial Flutter
/ epidemiology
Cardiotonic Agents
/ therapeutic use
Comorbidity
Diuretics
/ therapeutic use
Dopamine
/ therapeutic use
Dyspnea
/ physiopathology
Edema, Cardiac
/ drug therapy
Female
Heart Failure
/ drug therapy
Humans
Linear Models
Logistic Models
Male
Middle Aged
Natriuretic Agents
/ therapeutic use
Natriuretic Peptide, Brain
/ metabolism
Peptide Fragments
/ metabolism
Prognosis
Proportional Hazards Models
Stroke Volume
Treatment Outcome
atrial fibrillation
atrial flutter
body weight
decongestion
heart failure
Journal
JACC. Heart failure
ISSN: 2213-1787
Titre abrégé: JACC Heart Fail
Pays: United States
ID NLM: 101598241
Informations de publication
Date de publication:
01 2019
01 2019
Historique:
received:
22
08
2018
revised:
26
09
2018
accepted:
29
09
2018
pubmed:
10
11
2018
medline:
2
7
2020
entrez:
10
11
2018
Statut:
ppublish
Résumé
This study sought to characterize the course of decongestion among patients hospitalized for acute heart failure (AHF) by history of atrial fibrillation (AF) and/or atrial flutter (AFL). AF/AFL and chronic heart failure (HF) commonly coexist. Little is known regarding the impact of AF/AFL on relief of congestion among patients who develop AHF. We pooled patients from 3 randomized trials of AHF conducted within the Heart Failure Network, the DOSE (Diuretic Optimization Strategies) trial, the ROSE (Renal Optimization Strategies) trial, and the CARRESS-HF (Cardiorenal Rescue Study in Acute Decompensated Heart Failure) trial. The association between history of AF/AFL and in-hospital changes in various metrics of congestion was assessed using covariate-adjusted linear and ordinal logistic regression models. Of 750 unique patients, 418 (56%) had a history of AF/AFL. Left ventricular ejection fraction was higher (35% vs. 27%, respectively; p < 0.001), and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels were nonsignificantly lower at baseline (4,210 pg/ml vs. 5,037 pg/ml, respectively; p = 0.27) in patients with AF/AFL. After adjustment of covariates, history of AF/AFL was associated with less substantial loss of weight (-5.7% vs. -6.5%, respectively; p = 0.02) and decrease in NT-proBNP levels (-18.7% vs. -31.3%, respectively; p = 0.003) by 72 or 96 h. History of AF/AFL was also associated with a blunted increase in global sense of well being at 72 or 96 h (p = 0.04). There was no association between history of AF/AFL and change in orthodema congestion score (p = 0.67) or 60-day composite clinical endpoint (all-cause mortality or any rehospitalization; hazard ratio: 1.21; 95% confidence interval: 0.92 to 1.59; p = 0.17). More than half of the patients admitted with AHF had a history of AF/AFL. History of AF/AFL was independently associated with a blunted course of in-hospital decongestion. Further research is required to understand the utility of specific therapies targeting AF/AFL during hospitalization for AHF.
Sections du résumé
OBJECTIVES
This study sought to characterize the course of decongestion among patients hospitalized for acute heart failure (AHF) by history of atrial fibrillation (AF) and/or atrial flutter (AFL).
BACKGROUND
AF/AFL and chronic heart failure (HF) commonly coexist. Little is known regarding the impact of AF/AFL on relief of congestion among patients who develop AHF.
METHODS
We pooled patients from 3 randomized trials of AHF conducted within the Heart Failure Network, the DOSE (Diuretic Optimization Strategies) trial, the ROSE (Renal Optimization Strategies) trial, and the CARRESS-HF (Cardiorenal Rescue Study in Acute Decompensated Heart Failure) trial. The association between history of AF/AFL and in-hospital changes in various metrics of congestion was assessed using covariate-adjusted linear and ordinal logistic regression models.
RESULTS
Of 750 unique patients, 418 (56%) had a history of AF/AFL. Left ventricular ejection fraction was higher (35% vs. 27%, respectively; p < 0.001), and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels were nonsignificantly lower at baseline (4,210 pg/ml vs. 5,037 pg/ml, respectively; p = 0.27) in patients with AF/AFL. After adjustment of covariates, history of AF/AFL was associated with less substantial loss of weight (-5.7% vs. -6.5%, respectively; p = 0.02) and decrease in NT-proBNP levels (-18.7% vs. -31.3%, respectively; p = 0.003) by 72 or 96 h. History of AF/AFL was also associated with a blunted increase in global sense of well being at 72 or 96 h (p = 0.04). There was no association between history of AF/AFL and change in orthodema congestion score (p = 0.67) or 60-day composite clinical endpoint (all-cause mortality or any rehospitalization; hazard ratio: 1.21; 95% confidence interval: 0.92 to 1.59; p = 0.17).
CONCLUSIONS
More than half of the patients admitted with AHF had a history of AF/AFL. History of AF/AFL was independently associated with a blunted course of in-hospital decongestion. Further research is required to understand the utility of specific therapies targeting AF/AFL during hospitalization for AHF.
Identifiants
pubmed: 30409707
pii: S2213-1779(18)30712-1
doi: 10.1016/j.jchf.2018.09.008
pmc: PMC6320310
mid: NIHMS1509056
pii:
doi:
Substances chimiques
Cardiotonic Agents
0
Diuretics
0
Natriuretic Agents
0
Peptide Fragments
0
pro-brain natriuretic peptide (1-76)
0
Natriuretic Peptide, Brain
114471-18-0
Dopamine
VTD58H1Z2X
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
47-55Subventions
Organisme : NHLBI NIH HHS
ID : U10 HL110336
Pays : United States
Organisme : NHLBI NIH HHS
ID : U10 HL110338
Pays : United States
Organisme : NCATS NIH HHS
ID : KL2 TR002542
Pays : United States
Organisme : NHLBI NIH HHS
ID : U10 HL110342
Pays : United States
Organisme : NHLBI NIH HHS
ID : U10 HL084904
Pays : United States
Organisme : NHLBI NIH HHS
ID : U10 HL110312
Pays : United States
Organisme : NHLBI NIH HHS
ID : T32 HL069771
Pays : United States
Organisme : NHLBI NIH HHS
ID : U10 HL110262
Pays : United States
Organisme : NHLBI NIH HHS
ID : T32 HL069749
Pays : United States
Organisme : NHLBI NIH HHS
ID : U10 HL110337
Pays : United States
Organisme : NHLBI NIH HHS
ID : U10 HL110302
Pays : United States
Organisme : NHLBI NIH HHS
ID : U10 HL110297
Pays : United States
Organisme : NIGMS NIH HHS
ID : U54 GM115428
Pays : United States
Organisme : NHLBI NIH HHS
ID : U10 HL110309
Pays : United States
Informations de copyright
Copyright © 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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