Abstract 3147: Characteristics and Prognosis of African American Patients with Atrial Fibrillation in the African American Heart Failure Trial
Introduction: The presence of atrial fibrillation (AF) in patients (pts) with heart failure (HF) is associated with increased morbidity and mortality. African Americans (AA) with HF suffer higher adverse outcomes. Not much is known of the characteristics and prognosis of AA pts with AF and HF.
Method: In A-HeFT, 1050 AA pts with NYHA class lll/lV systolic HF, well treated (87% beta-blockers, 93% ACEI and/or ARB, 39% spironolactone) were randomized to added fixed-dose combination of isosorbide dinitrate/hydralazine (FDC I/H) or placebo up to 18 months. Mean follow-up was 12.8 months.
Results: AF was observed in 183 (17%) pts at baseline or during the trial. AF pts compared to those with no AF were significantly older, more likely to be male, had lower systolic BP and diastolic BP, higher BNP and creatinine levels, and higher usage of digitalis glycoside. They were also more likely to have an all cause (52% vs. 38%, p < 0.001) or HF (27% vs. 19%, p = 0.026) hospitalization. In addition, AF pts have a greater frequency of readmissions than those without AF (p = 0.012). AF increased the risk of mortality (HR = 1.77, p = 0.018) in AA pts with HF and had a greater impact on females (Fig 1⇓). FDC I/H added to the following subgroups was associated with significant reduction of mortality in pts with AF: all AF pts, HR = 0.21, p = 0.002; ACEI and/or ARB users, HR = 0.27, p = 0.014; beta-blocker users, HR = 0.14, p = 0.003; ACEI and/or ARB and beta-blocker users, HR = 0.18, p = 0.014.
Conclusions: The existence of AF in AA pts with HF is associated with more hospitalizations and worsened survival, especially in AA women. The addition of FDC I/H to evidence-based meds for HF greatly reduced this increased morbidity and mortality.