Tags

Type your tag names separated by a space and hit enter

Atrial fibrillation or flutter on initial electrocardiogram is associated with worse outcomes in patients admitted for worsening heart failure with reduced ejection fraction: findings from the EVEREST Trial.
Am Heart J. 2012 Dec; 164(6):884-92.e2.AH

Abstract

BACKGROUND

Heart failure (HF) complicated by atrial fibrillation/flutter (AF/AFL) is associated with worse outcomes. However, the clinical profile and outcomes of patients following hospitalization for HF with AF/AFL on initial electrocardiogram (ECG) has not been well studied.

METHODS

EVEREST was a randomized trial of vasopressin-2 receptor blockade, in addition to standard therapy, in 4133 patients hospitalized with HF with ejection fraction ≤40%. A post hoc analysis was performed comparing the clinical characteristics and outcomes [all-cause mortality and cardiovascular mortality/HF hospitalization] of patients with AF/AFL versus sinus rhythm (SR) on baseline ECG, which were centrally analyzed. Times to events were compared using log-rank tests and Cox regression models.

RESULTS

Of the 4133 patients, 1195 (29%) were classified with AF/AFL and 2071(50%) with SR. The remaining patients (21%) were excluded because ECGs were unavailable (n = 106), rhythm was paced (n = 727), or junctional/other supraventricular (n = 34). AF/AFL patients were older, with increased weight, faster heart rate, higher blood urea nitrogen, and natriuretic peptide levels compared to SR patients. Anticoagulation was prescribed in 67% of AF/AFL patients on discharge. AF/AFL patients were less likely to receive β-blockers or angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (all P < .05). After risk adjustment, AF/AFL was associated with increased mortality (hazard ratio 1.23; 95% CI, 1.04-1.46) and cardiovascular mortality/HF hospitalization (hazard ratio 1.26; 95% CI, 1.07-1.47).

CONCLUSION

AF/AFL on initial ECG in patients hospitalized with HF with reduced ejection fraction is associated with lower use of evidence-based therapies and increased mortality and rehospitalization compared to patients in SR.

Authors+Show Affiliations

Duke University Medical Center, Durham, NC, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23194489

Citation

Mentz, Robert J., et al. "Atrial Fibrillation or Flutter On Initial Electrocardiogram Is Associated With Worse Outcomes in Patients Admitted for Worsening Heart Failure With Reduced Ejection Fraction: Findings From the EVEREST Trial." American Heart Journal, vol. 164, no. 6, 2012, pp. 884-92.e2.
Mentz RJ, Chung MJ, Gheorghiade M, et al. Atrial fibrillation or flutter on initial electrocardiogram is associated with worse outcomes in patients admitted for worsening heart failure with reduced ejection fraction: findings from the EVEREST Trial. Am Heart J. 2012;164(6):884-92.e2.
Mentz, R. J., Chung, M. J., Gheorghiade, M., Pang, P. S., Kwasny, M. J., Ambrosy, A. P., Vaduganathan, M., O'Connor, C. M., Swedberg, K., Zannad, F., Konstam, M. A., & Maggioni, A. P. (2012). Atrial fibrillation or flutter on initial electrocardiogram is associated with worse outcomes in patients admitted for worsening heart failure with reduced ejection fraction: findings from the EVEREST Trial. American Heart Journal, 164(6), 884-e2. https://doi.org/10.1016/j.ahj.2012.09.011
Mentz RJ, et al. Atrial Fibrillation or Flutter On Initial Electrocardiogram Is Associated With Worse Outcomes in Patients Admitted for Worsening Heart Failure With Reduced Ejection Fraction: Findings From the EVEREST Trial. Am Heart J. 2012;164(6):884-92.e2. PubMed PMID: 23194489.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Atrial fibrillation or flutter on initial electrocardiogram is associated with worse outcomes in patients admitted for worsening heart failure with reduced ejection fraction: findings from the EVEREST Trial. AU - Mentz,Robert J, AU - Chung,Matthew J, AU - Gheorghiade,Mihai, AU - Pang,Peter S, AU - Kwasny,Mary J, AU - Ambrosy,Andrew P, AU - Vaduganathan,Muthiah, AU - O'Connor,Christopher M, AU - Swedberg,Karl, AU - Zannad,Faiez, AU - Konstam,Marvin A, AU - Maggioni,Aldo P, Y1 - 2012/10/29/ PY - 2012/09/04/received PY - 2012/09/21/accepted PY - 2012/12/1/entrez PY - 2012/12/1/pubmed PY - 2013/2/13/medline SP - 884 EP - 92.e2 JF - American heart journal JO - Am Heart J VL - 164 IS - 6 N2 - BACKGROUND: Heart failure (HF) complicated by atrial fibrillation/flutter (AF/AFL) is associated with worse outcomes. However, the clinical profile and outcomes of patients following hospitalization for HF with AF/AFL on initial electrocardiogram (ECG) has not been well studied. METHODS: EVEREST was a randomized trial of vasopressin-2 receptor blockade, in addition to standard therapy, in 4133 patients hospitalized with HF with ejection fraction ≤40%. A post hoc analysis was performed comparing the clinical characteristics and outcomes [all-cause mortality and cardiovascular mortality/HF hospitalization] of patients with AF/AFL versus sinus rhythm (SR) on baseline ECG, which were centrally analyzed. Times to events were compared using log-rank tests and Cox regression models. RESULTS: Of the 4133 patients, 1195 (29%) were classified with AF/AFL and 2071(50%) with SR. The remaining patients (21%) were excluded because ECGs were unavailable (n = 106), rhythm was paced (n = 727), or junctional/other supraventricular (n = 34). AF/AFL patients were older, with increased weight, faster heart rate, higher blood urea nitrogen, and natriuretic peptide levels compared to SR patients. Anticoagulation was prescribed in 67% of AF/AFL patients on discharge. AF/AFL patients were less likely to receive β-blockers or angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (all P < .05). After risk adjustment, AF/AFL was associated with increased mortality (hazard ratio 1.23; 95% CI, 1.04-1.46) and cardiovascular mortality/HF hospitalization (hazard ratio 1.26; 95% CI, 1.07-1.47). CONCLUSION: AF/AFL on initial ECG in patients hospitalized with HF with reduced ejection fraction is associated with lower use of evidence-based therapies and increased mortality and rehospitalization compared to patients in SR. SN - 1097-6744 UR - https://www.unboundmedicine.com/medline/citation/23194489/Atrial_fibrillation_or_flutter_on_initial_electrocardiogram_is_associated_with_worse_outcomes_in_patients_admitted_for_worsening_heart_failure_with_reduced_ejection_fraction:_findings_from_the_EVEREST_Trial_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-8703(12)00654-0 DB - PRIME DP - Unbound Medicine ER -