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Clinical Research in Cardiology
Erschienen in: Clinical Research in Cardiology 1/2022

14.06.2021 | Original Paper

New-onset atrial fibrillation in patients with worsening heart failure and coronary artery disease: an analysis from the COMMANDER-HF trial

verfasst von: João Pedro Ferreira, John G. Cleland, Carolyn S. P. Lam, Stefan D. Anker, Mandeep R. Mehra, Dirk J. van Veldhuisen, William M. Byra, David A. LaPolice, Barry Greenberg, Faiez Zannad

Erschienen in: Clinical Research in Cardiology | Ausgabe 1/2022

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Abstract

Background

Atrial fibrillation (AF) in the presence of heart failure (HF) is associated with poor outcomes including a high-risk of stroke and other thromboembolic events. Identifying patients without AF who are at high-risk of developing this arrhythmia has important clinical implications.

Aims

To develop a risk score to identify HF patients at high risk of developing AF.

Methods

The COMMANDER-HF trial enrolled 5022 patients with HF and a LVEF ≤ 40%, history of coronary artery disease, and absence of AF at baseline (confirmed with an electrocardiogram). Patients were randomized to either rivaroxaban (2.5 mg bid) or placebo. New-onset AF was confirmed by the investigator at study visits.

Results

241 (4.8%) patients developed AF during the follow-up (median 21 months). Older age (≥ 65 years), LVEF < 35%, history of PCI or CABG, White race, SBP < 110 mmHg, and higher BMI (≥ 25 kg/m2) were independently associated with risk of new-onset AF, whereas the use of DAPT was associated with a lower risk of new-onset AF. We then built a risk score from these variables (with good accuracy C-index = 0.71) and calibration across observed and predicted tertiles of risk. New-onset AF events rates increased steeply by increasing tertiles of the risk-score. Compared to tertile 1, the risk of new-onset AF was 2.5-fold higher in tertile 2, and 6.3-fold higher in tertile 3. Rivaroxaban had no effect in reducing new-onset AF. In time-updated models, new-onset AF was associated with a higher risk of subsequent all-cause death: HR (95%CI) 1.38 (1.11–1.73).

Conclusions

A well-calibrated risk-score identified patients at risk of new-onset AF in the COMMANDER-HF trial. Patients who developed AF had a higher risk of subsequent death.

Graphic abstract

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Metadaten
Titel
New-onset atrial fibrillation in patients with worsening heart failure and coronary artery disease: an analysis from the COMMANDER-HF trial
verfasst von
João Pedro Ferreira
John G. Cleland
Carolyn S. P. Lam
Stefan D. Anker
Mandeep R. Mehra
Dirk J. van Veldhuisen
William M. Byra
David A. LaPolice
Barry Greenberg
Faiez Zannad
Publikationsdatum
14.06.2021
Verlag
Springer Berlin Heidelberg
Erschienen in
Clinical Research in Cardiology / Ausgabe 1/2022
Print ISSN: 1861-0684
Elektronische ISSN: 1861-0692
DOI
https://doi.org/10.1007/s00392-021-01891-2

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