Author + information
- Received September 20, 2016
- Accepted September 30, 2016
- Published online December 26, 2016.
- Ambarish Pandey, MDa,
- Sunghee Kim, PhDb,
- Curtiss Moore, MDa,
- Laine Thomas, PhDb,
- Bernard Gersh, MBChB, DPhilc,
- Larry A. Allen, MD, MHSd,
- Peter R. Kowey, MDe,
- Kenneth W. Mahaffey, MDf,
- Elaine Hylek, MD, MPHg,
- Eric D. Peterson, MD, MPHb,
- Jonathan P. Piccini, MD, MHSb,
- Gregg C. Fonarow, MDh,∗ (, )
- ORBIT-AF Investigators and Patients
- aDivision of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
- bDivision of Cardiology, Duke Clinical Research Institute, Durham, North Carolina
- cDepartment of Cardiovascular Diseases, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota
- dDepartment of Medicine, Section of Advanced Heart Failure, University of Colorado School of Medicine, Aurora, Colorado
- eLankenau Institute for Medical Research, Wynnewood, Pennsylvania
- fStanford Center for Clinical Research (SCCR), Department of Medicine, Stanford University School of Medicine, Stanford, California
- gBoston University School of Medicine, Boston, Massachusetts
- hDivision of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, California
- ↵∗Reprint requests and correspondence:
Dr. Gregg C. Fonarow, Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan UCLA Medical Center, 10833 LeConte Avenue, Room 47-123 CHS, Los Angeles, California 90095-1679.
Objectives The purpose of this study was to determine the significant clinical predictors of incident heart failure (HF) and its prognostic effect on long-term outcomes among community-based patients with established atrial fibrillation (AF).
Background AF is associated with an increased risk of HF. However, in this population, little focus is placed on risk stratification for and the prevention of HF.
Methods Patients with AF but without HF at baseline enrolled in the ORBIT-AF (Outcomes Registry for Informed Treatment of Atrial Fibrillation) registry were included. Separate multivariable-adjusted Cox frailty regression models were used to identify significant predictors of HF incidence and determine the associated risk of adverse clinical events.
Results The study included 6,545 participants with AF from 173 participating sites. Incident HF developed in 236 participants (3.6%) over the 2-year follow-up period; ejection fraction was preserved (>40%) in 64%, reduced (≤40%) in 13.5%, and missing in 22.5%. In multivariable analysis, traditional HF risk factors (age, coronary artery disease, renal dysfunction, and valvular disease), presence of permanent AF (hazard ratio [HR]: 1.60 [95% confidence interval (CI): 1.18 to 2.16]; reference group: paroxysmal AF), and elevated baseline heart rate (HR: 1.07 [95% CI: 1.02 to 1.13] per 5 beats/min higher heart rate) were independently associated with incident HF risk. Incident HF among patients with AF was independently associated with higher risk of mortality, all-cause hospitalization, and bleeding events.
Conclusions Incident HF among patients with AF is common, is more likely to be HF with preserved ejection fraction, and is associated with poor long-term outcomes. Traditional HF risk factors, AF type, and baseline heart rate are independent clinical predictors of incident HF.
The ORBIT-AF registry is sponsored by Janssen Scientific Affairs, LLC. Dr. Gersh has served on the data safety and monitoring board for Baxter Healthcare Corporation, Cardiovascular Research Foundation, St. Jude Medical, and Boston Scientific; has been a steering committee member for Medtronic; and has been a member of the executive committee for Ortho-McNeil Janssen Scientific Affairs. Dr. Allen has received grants from the American Heart Association, National Institutes of Health, and the Patient-Centered Outcomes Research Institute; and has received consultancy fees from Janssen, Novartis, ZS Pharma, and St. Jude Medical. Dr. Kowey has served as a consultant to or on the advisory board of Johnson & Johnson, Daiichi Sankyo, Sanofi, Boehringer Ingelheim, Merck, Bristol-Myers Squibb, and Portola. Dr. Mahaffey’s financial disclosures are available at https://med.stanford.edu/profiles/kenneth-mahaffey?tab=research-and-scholarship. Dr. Hylek has received honoraria for consultancy from Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi Sankyo, Janssen, Medtronic, Portola, and Pfizer. Dr. Peterson has received research grants from the American Heart Association, the American College of Cardiology, Janssen Pharmaceuticals, Eli Lilly, and the Society of Thoracic Surgeons; has served as a consultant to or on the advisory board of Merck & Co., Boehringer Ingelheim, Genentech, Sanofi-Aventis, and Janssen Pharmaceuticals; and has received personal fees from AstraZeneca, Bayer, Regeneron, and Valeant. Dr. Piccini has received research grants from Johnson & Johnson/Janssen Pharmaceuticals and Boston Scientific Corp; has received grants to his institution from Janssen, Boston Scientific, ARCA biopharma, St. Jude Medical, ResMed, and Gilead; has received other research support from Johnson & Johnson/Janssen Pharmaceuticals; and has received consultant/advisory board fees from Forest Laboratories, Medtronic, GlaxoSmithKline, Amgen, and Johnson & Johnson/Janssen Pharmaceuticals. Dr. Fonarow has received research support from AHRQ; and has received consultancy fees from Janssen and Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received September 20, 2016.
- Accepted September 30, 2016.
- American College of Cardiology Foundation