Atrial fibrillation in chronic heart failure patients with reduced ejection fraction: The CHECK-HF registry

Jesse F Veenis,Hans-Peter Brunner-La Rocca,Gerard C.M Linssen,Frank J.J Smeele,Noëmi T.A.E Wouters,Paul H.M Westendorp,Philip C Rademaker,Martin E.W Hemels,Michiel Rienstra,Arno W Hoes,Jasper J Brugts

doi:10.1016/j.ijcard.2020.03.001

Abstract

BackgroundAtrial fibrillation (AF) is common in chronic heart failure (HF) patients and influences the choice and effects of drug and device therapy. In this large real-world HF registry, we studied whether the presence of AF affects the prescription of guideline-recommended HF therapy. MethodsWe analyzed 8253 patients with chronic HF with reduced ejection fraction (HFrEF) from 34 Dutch outpatient clinics included in the period between 2013 and 2016 treated according to the 2012 ESC guidelines. Results2109 (25.6%) of these patients were in AF (mean age 76.8 ± 9.2 years, 65.0% were men) and 6.144 (74.4%) had no AF (mean age 70.7 ± 12.2 years, 63.6% were men). Patients with AF more often received beta-blockers (81.7% vs. 79.7%, p = 0.04), MRAs (57.1% vs. 51.7%, p < 0.01), diuretics (89.7% vs. 80.6%, p < 0.01) and digoxin (40.1% vs. 9.3%, p < 0.01) compared to patients without AF, whereas they less often receive renin-angiotensin-system (RAS)-inhibitors (76.1% vs. 83.1%, p < 0.01). The number of patients who received beta-blockers, RAS-inhibitor and MRA at ≥50% of the recommended target dose was comparable between those with and without AF (16.6% vs. 15.2%, p = 0.07). ConclusionIn this large cohort of chronic HFrEF patients, the prevalence of AF was high and we observed significant differences in prescription of both guideline-recommended HF between patients with and without AF.

Highlights

Atrial fibrillation (AF) is a common comorbidity in chronic heart failure (HF) patients, with a prevalence that has been reported from 10% up to 50–60%, depending on age and severity of HF [1,2,3]
Between 2013 and 2016, all centers included patients diagnosed with HF-based on symptoms, signs, ECG, biomarkers and echocardiography according to the 2012 European Society of Cardiology (ESC) Guideline on HF [10], who were seen at the outpatient HF clinic (96%) or general cardiology outpatient clinic (4%) if no specific HF clinic was present
Of all HF with reduced ejection fraction (HFrEF) patients, 2109 (25.6%) patients had AF on the entry-ECG at the most recent out-patient clinic visit or had a documented history of AF, 4901 (59.4%) had sinus rhythm, 1141 (13.8%) had pacemaker rhythm and 102 (1.2) had an ectopic rhythm (in total 6144 (74.4%) had no AF)

Summary

Introduction

Atrial fibrillation (AF) is a common comorbidity in chronic heart failure (HF) patients, with a prevalence that has been reported from 10% up to 50–60%, depending on age and severity of HF [1,2,3]. Atrial fibrillation (AF) is common in chronic heart failure (HF) patients and influences the choice and effects of drug and device therapy. In this large real-world HF registry, we studied whether the presence of AF affects the prescription of guideline-recommended HF therapy. Conclusion: In this large cohort of chronic HFrEF patients, the prevalence of AF was high and we observed significant differences in prescription of both guideline-recommended HF between patients with and without AF

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