• JACC. Heart failure · Jan 2019

    History of Atrial Fibrillation and Trajectory of Decongestion in Acute Heart Failure.

    • Ravi B Patel, Muthiah Vaduganathan, Aruna Rikhi, Hrishikesh Chakraborty, Stephen J Greene, Adrian F Hernandez, G Michael Felker, Margaret M Redfield, Javed Butler, and Sanjiv J Shah.
    • Department of Medicine, Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois. Electronic address: ravi.patel@northwestern.edu.
    • JACC Heart Fail. 2019 Jan 1; 7 (1): 47-55.

    ObjectivesThis study sought to characterize the course of decongestion among patients hospitalized for acute heart failure (AHF) by history of atrial fibrillation (AF) and/or atrial flutter (AFL).BackgroundAF/AFL and chronic heart failure (HF) commonly coexist. Little is known regarding the impact of AF/AFL on relief of congestion among patients who develop AHF.MethodsWe pooled patients from 3 randomized trials of AHF conducted within the Heart Failure Network, the DOSE (Diuretic Optimization Strategies) trial, the ROSE (Renal Optimization Strategies) trial, and the CARRESS-HF (Cardiorenal Rescue Study in Acute Decompensated Heart Failure) trial. The association between history of AF/AFL and in-hospital changes in various metrics of congestion was assessed using covariate-adjusted linear and ordinal logistic regression models.ResultsOf 750 unique patients, 418 (56%) had a history of AF/AFL. Left ventricular ejection fraction was higher (35% vs. 27%, respectively; p < 0.001), and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels were nonsignificantly lower at baseline (4,210 pg/ml vs. 5,037 pg/ml, respectively; p = 0.27) in patients with AF/AFL. After adjustment of covariates, history of AF/AFL was associated with less substantial loss of weight (-5.7% vs. -6.5%, respectively; p = 0.02) and decrease in NT-proBNP levels (-18.7% vs. -31.3%, respectively; p = 0.003) by 72 or 96 h. History of AF/AFL was also associated with a blunted increase in global sense of well being at 72 or 96 h (p = 0.04). There was no association between history of AF/AFL and change in orthodema congestion score (p = 0.67) or 60-day composite clinical endpoint (all-cause mortality or any rehospitalization; hazard ratio: 1.21; 95% confidence interval: 0.92 to 1.59; p = 0.17).ConclusionsMore than half of the patients admitted with AHF had a history of AF/AFL. History of AF/AFL was independently associated with a blunted course of in-hospital decongestion. Further research is required to understand the utility of specific therapies targeting AF/AFL during hospitalization for AHF.Copyright © 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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