Factors associated with disease progression in patients with atrial fibrillation and heart failure anticoagulated with rivaroxaban

Nicolás Manito; J.M. Cepeda-Rodrigo; Núria Farré; M. Castillo Orive; Enrique Galve; Javier Jiménez‐Candil; José Manuel García‐Pinilla; Eduardo Sebastián López Sánchez; Carles Ràfols; Juan José Gómez‐Doblas

doi:10.1002/clc.24189

November 29, 2023Clinical CardiologyOpen Access

Factors associated with disease progression in patients with atrial fibrillation and heart failure anticoagulated with rivaroxaban

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Why the study?

Patients with AF and HF face a high risk of thromboembolism and other adverse outcomes, prompting the need to explore risk factors associated with HF worsening in those taking rivaroxaban.

Structured PICO

P

Population

Adults with atrial fibrillation (AF) and chronic heart failure (HF), receiving rivaroxaban ≥4 months before entering, in Spain.

I

Intervention

Rivaroxaban

O

Outcome

HF worsening (defined as first hospitalization or emergency visit because of HF exacerbation)hard clinical

In patients with AF and HF treated with rivaroxaban, older age, COPD, prior VKA use, and restrictive/infiltrative cardiomyopathies are independent predictors of HF worsening.

Implication

May inform risk stratification in anticoagulated AF-HF patients; hypothesis-generating pending prospective validation.

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: -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.