Atrial fibrillation in patients with HFrEF was associated with a higher risk of all-cause death and heart failure hospitalization compared to those without AF (aHR 2.12; 95% CI 1.16-3.86).
Cohort (n=321)
No
Does the presence of atrial fibrillation worsen the composite outcome of all-cause death and hospitalization for heart failure in patients with HFrEF on contemporary medical therapy?
In patients with HFrEF on contemporary medical therapy, the presence of atrial fibrillation is associated with a significantly higher risk of heart failure hospitalization and adverse events, despite similar trajectories in LVEF and renal function.
Effect estimate: aHR 2.12 (95% CI 1.16-3.86)
Abstract Background Real-world data on the trajectories of renal function, left ventricular ejection fraction (LVEF) and clinical outcomes in patients with heart failure with reduced ejection fraction (HFrEF) and atrial fibrillation (AF) remain scarce. Purpose This study aimed to describe changes in estimated glomerular filtration rate (eGFR) and LVEF, as well as clinical outcomes, in a contemporary cohort of patients. Methods This single-center, retrospective registry included patients prescribed Angiotensin Receptor-Neprilysin Inhibitor (ARNi) or Sodium-Glucose Transport Protein 2 inhibitors (SGLT2i) according to Italian Drug Agency guidelines. Results A total of 321 patients (median age 67 58-74 years, 19.3% females; median NYHA class II II-III) were included. Among these, 134 (41.7%) patients had AF and 187 (58.3%) did not. At baseline, patients with AF were less frequently prescribed with ARNi (67.9 vs. 80.2%, p=0.017), while no differences were observed concerning the prescription of SGT2i (44.8% vs. 34.2%, p=0.072). AF patients had lower median eGFR values and higher median LVEF values (32 30-35 vs. 30 28-35, p=0.011). At 6- and 12-month follow-ups, renal function declined similarly in both groups, though AF patients consistently had lower eGFR values, with a ≥30% eGFR decline occurring in 14.6% of the overall cohort (Figure 1, panel A for the overall cohort; panel B stratified by AF status). LVEF improvement ≥10% was less marked in AF patients (68.4%vs. 56.1%, p=0.041), but 62.3% of patients achieved LVEF 35% at the last available follow-up, with no differences based on the presence of AF (59.3% vs. 64.4%, p=0.443). During a median follow-up of 582 339-1481 days, 60 (17.8%) events of the primary composite outcome of all-cause death and hospitalization for heart failure (hHF) were reported. Patients with AF showed a higher risk of the primary outcome (aHR, 95% CI: 2.12, 1.16-3.86) and of hHF (2.80, 1.44-5.46), though the risk of all-cause death did not differ between groups. When assessing the association between the delta eGFR overall changes and the risk of the primary outcome (Figure 2, panel A), a statistically significant association for an increased risk of adverse events when eGFR decreases at least -30% was found (p= 0.0443, p non-linearity=0.329). Consistently, the negative delta eGFR changes from 6-month follow-up were statistically associated with a higher risk of adverse events, with a non-linear relationship (p=0.005, p non-linearity=0.002) (Figure 2, panel B). Conclusions Despite lower baseline renal function, AF patients exhibited similar LVEF improvement and renal decline as those without AF, emphasizing the importance of guideline-directed medical therapy. However, AF was associated with a higher risk of adverse events, primarily driven by HF hospitalization.Changes in renal function delta eGFR changes and outcome
Mantovani et al. (Sat,) conducted a cohort in Heart failure with reduced ejection fraction (HFrEF) (n=321). Atrial fibrillation vs. No atrial fibrillation was evaluated on Composite of all-cause death and hospitalization for heart failure (hHF) (aHR 2.12, 95% CI 1.16-3.86). Atrial fibrillation in patients with HFrEF was associated with a higher risk of all-cause death and heart failure hospitalization compared to those without AF (aHR 2.12; 95% CI 1.16-3.86).