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


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Publication Details
Author list: Seraj Abualnaja, Mohua Podder, Adrian F. Hernandez, John J. V. McMurray, Randall C. Starling, Christopher M. O’Connor, Robert M. Califf, Paul W. Armstrong, Justin A. Ezekowitz,
Publisher: American Heart Association: JAHA / Wiley
Publication year: 2015
Journal: Journal of the American Heart Association
Journal name in source: Journal of the American Heart Association
Volume number: 4
Issue number: 8
Start page: 7
End page: 8
Number of pages: 2
ISSN: 2047-9980
Web of Science ID: 000364150900018
PubMed ID: 26304935
Scopus ID: 85016925384


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.

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Keywords
acute heart failure, atrial fibrillation, clinical trials, outcome

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Last updated on 2018-13-03 at 14:49