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EP News—Section Editors: T. Jared Bunch, Penelope A. Boyden, N.A. Mark Estes III, Erica S. Zado| Volume 15, ISSUE 2, P313, February 01, 2018

EP News: Allied Professionals

  • Erica S. Zado
    Correspondence
    Address reprint requests and correspondence: Ms Erica S. Zado, Section of Cardiac Electrophysiology, Cardiovascular Division, Hospital of the University of Pennsylvania, Founders 9, 3400 Spruce St, Philadelphia, PA 19104.
    Affiliations
    Section of Cardiac Electrophysiology, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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Published:December 20, 2017DOI:https://doi.org/10.1016/j.hrthm.2017.12.012
      Using data from 2 large randomized drug studies assessing outcome in patients with heart failure (HF) with reduced ejection fraction (HFrEF), Mogensen et al (J Am Coll Cardiol 2017;70:2490, PMID 29145948) sought to assess the effect of the presence and type of atrial fibrillation (AF) on the outcome. Of the 15,415 patients included in the 2 trials, 5461 (35.6%) had a history of AF. These patients were grouped according to the type of AF, with 1645 (30%) having paroxysmal AF (PAF), 3770 (69%) with persistent or permanent AF (pers/perm AF), and 369 who developed new-onset AF during the course of the study. The groups were analyzed by comparing them to each other and to those with no history of AF (9828 [64%]) with regard to study outcomes (composite outcome of cardiovascular death defined as death due to worsening HF, stroke, sudden death, all-cause mortality, and HF hospitalization). Patients with AF reached the composite end points at a higher rate than did those without AF; however, in adjusted analyses this was driven mainly by higher rates in those with PAF rather than those with pers/perm AF. Patients with PAF had higher rates of HF hospitalization and stroke than did those with no AF or pers/perm AF. Patients who fared the worst overall were those with new-onset AF with higher rates of stroke, all-cause, and cardiovascular mortality, and HF hospitalization as compared with other groups with AF and those without AF. Importantly, oral anticoagulation was underutilized (71% in patients with pers/perm AF, 53% in those with PAF, and 16% in those with new-onset AF) in all AF groups despite a high CHA2DS2-VASc score of ≥2 in 90% of patients. The authors conclude that patients with HFrEF and PAF have higher risk of HF hospitalization and stroke, highlighting the need for oral anticoagulation therapy in these patients. In addition, new-onset AF was associated with worse outcomes, which may be mitigated by anticoagulation and close follow-up for HF decompensation.
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