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

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/$ 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 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 Risk of new-onset atrial fibrillation in patients with HFrEF and coronary artery disease.

Medienart:	E-Artikel

Erscheinungsjahr:	2021
Erschienen:	2021

Enthalten in:	Zur Gesamtaufnahme - volume:111
Enthalten in:	Zeitschrift für Kardiologie - 111(2021), 1 vom: 14. Juni, Seite 50-59

Sprache:	Englisch

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

Links:	Volltext [lizenzpflichtig]

Themen:	Heart failure New-onset atrial fibrillation Rivaroxaban

Anmerkungen:	© Springer-Verlag GmbH Germany, part of Springer Nature 2021

doi:	10.1007/s00392-021-01891-2

funding:
Förderinstitution / Projekttitel:

PPN (Katalog-ID):	SPR045993246