In AF patients, cardiac amyloidosis was linked to higher 15-year mortality (63.3% vs 34.7%) and heart failure events (71.4% vs 45.0%) but similar stroke and bleeding rates.
Does the presence of cardiac amyloidosis increase mortality and heart failure events in patients with atrial fibrillation?
In patients with atrial fibrillation, comorbid cardiac amyloidosis is associated with significantly higher long-term mortality and heart failure events, as well as increased gastrointestinal bleeding, compared to those without amyloidosis.
Absolute Event Rate: 0% vs 0%
Abstract Background Atrial fibrillation (AF) is associated with increased stroke and mortality risk. In cardiac amyloidosis, characterized by extracellular protein deposition leading to restrictive heart failure, arrhythmias such as AF are common and poorly tolerated. Despite the risk of stroke and systemic embolism in these patients, evidence on managing AF in amyloidosis remains limited. Methods The study population consisted of patients included in AF nationwide population-based registry of Israel's largest health maintenance organization, between January 1st, 2010, and January 1st, 2020. Patients with AF and amyloidosis were compared in 3:1 to matched subjects without amyloidosis, for demographic, clinical characteristics and outcomes. Primary endpoints were survival rated and hospitalization for heart failure. Results Among 2,584 patients, 646 had amyloidosis, and 1,938 without amyloidosis. Mean age was 73.1 (11.09) years and 63.5% were male. Among baseline characteristics, CKD (chronic renal failure) and anaemia were significantly higher in amyloidosis patients (30.3% vs. 20.1%, p0.0001 and 42.1% vs. 35.4%, p=0.0026, respectively). No difference in heart failure (HF) between the groups. Only 2.2% patients in the amyloidosis group treated with Tafamidis. Anticoagulation therapy was significantly more frequent in amyloidosis patients (46.3% vs. 38.2%, p=0.0004). In 15 years follow up, mortality was significantly higher in amyloidosis patients (63.3% vs. 34.7%, p0.0001). HF events was also more prevalent in amyloidosis patients (71.4% vs. 45.0%, p0.0001). Similar rates of stroke between the groups (p=0.0759) with overall incidence of 13.9%. Bleeding rates were similar between groups (18.8% vs. 17.0%, p=0.3196), and gastrointestinal bleeding was more frequent in amyloidosis patients (21.6% vs. 16.5%, p=0.0044), required more blood transfusion (16.4% vs. 9.3%, p0.0001). Outcomes: In this nationwide, population-based study of patients with AF, amyloidosis was associated with significantly higher rates of mortality and heart failure events over 15 years, with similar rates of overall bleeding and stroke events.
Giladi et al. (Sat,) reported a other. In AF patients, cardiac amyloidosis was linked to higher 15-year mortality (63.3% vs 34.7%) and heart failure events (71.4% vs 45.0%) but similar stroke and bleeding rates.