Acute Heart Failure and Atrial Fibrillation: Insights From the Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure (ASCEND-HF) Trial

J Am Heart Assoc. 2015 Aug 24;4(8):e002092. doi: 10.1161/JAHA.115.002092.

Abstract

Background: Patients with acute heart failure (AHF) frequently have atrial fibrillation (AF), but how this affects patient-reported outcomes has not been well characterized.

Methods and results: We examined dyspnea improvement and clinical outcomes in 7007 patients in the Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure (ASCEND-HF) trial. At baseline, 2677 (38.2%) patients had current or a history of AF and 4330 (61.8%) did not. Patients with a history of AF were older than those without (72 vs. 63 years) and had more comorbidities and a higher median left ventricular ejection fraction (31% vs. 27%, P<0.001). Compared to those without AF, patients with AF had a similar mean ventricular rate on admission (81 vs. 83 beats per minute [bpm]; P=0.138) but a lower rate at discharge (75 vs. 78 bpm; P<0.001). There was no difference in dyspnea improvement between patients with and without AF at 6 hours (P=0.087), but patients with AF had less dyspnea improvement at 24 hours (P<0.001). Compared to patients without AF, patients with AF had a higher 30-day all-cause mortality rate (4.7% vs. 3.3%; P=0.005), a higher 30-day HF rehospitalisation rate (7.2% vs. 5.3%; P=0.001), and a higher coprimary composite outcome of 30-day death or readmission (11.6% vs. 8.6%; P<0.001). This difference persisted after adjustment for prognostic variables (adjusted odds ratio=1.19; (95% confidence interval, 1.02 to 1.38; P=0.029).

Conclusions: Among patients admitted to the hospital with AHF, current or a history of AF is associated with less dyspnea improvement and higher morbidity and mortality at 30-days, compared to those not in AF.

Clinical trial registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00475852.

Keywords: acute heart failure; atrial fibrillation; clinical trials; outcome.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Aged
  • Atrial Fibrillation / complications*
  • Atrial Fibrillation / diagnosis
  • Atrial Fibrillation / mortality
  • Atrial Fibrillation / physiopathology
  • Chi-Square Distribution
  • Dyspnea / diagnosis
  • Dyspnea / drug therapy*
  • Dyspnea / etiology
  • Dyspnea / mortality
  • Dyspnea / physiopathology
  • Female
  • Heart Failure / complications
  • Heart Failure / diagnosis
  • Heart Failure / drug therapy*
  • Heart Failure / mortality
  • Heart Failure / physiopathology
  • Humans
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Natriuretic Peptide, Brain / adverse effects
  • Natriuretic Peptide, Brain / therapeutic use*
  • Odds Ratio
  • Patient Readmission
  • Randomized Controlled Trials as Topic
  • Recovery of Function
  • Retrospective Studies
  • Risk Factors
  • Time Factors
  • Treatment Outcome

Substances

  • Natriuretic Peptide, Brain

Associated data

  • ClinicalTrials.gov/NCT00475852