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

Autores da FMUP

• João Pedro Melo Marques Pinho Ferreira

  Autor

Participantes de fora da FMUP

• Cleland, JG
• Lam, CSP
• Anker, SD
• Mehra, MR
• van Veldhuisen, DJ
• Byra, WM
• LaPolice, DA
• Greenberg, B
• Zannad, FAB -

Unidades de investigação

• Cirurgia e Fisiologia

• Laboratório Associado RISE- Rede de Investigação em Saúde

  

  Investigador

  Fernando Carlos De Landér Schmitt

Abstract

Background Atrial fibrillation (AF) in the presence of heart failure (HF) is associated with poor outcomes including a highrisk 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/m(2)) 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 newonset 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.

Keywords

• New-onset atrial fibrillation; Rivaroxaban; Heart failure