Abstract 14125: Prognostic Impact of and Risk Score for the Onset of Atrial Fibrillation in Patients at High Risk for Heart Failure -A Report From the CHART-2 Study
Background: The prognostic impact of atrial fibrillation (AF) in patients in Stage A/B, who are at high-risk for heart failure (HF), is unclear. Furthermore, there is no risk estimation model for AF onset in those patients.
Methods: We examined clinical background, treatments, and long-term prognosis of 5,382 consecutive patients with Stage A/B enrolled in our Chronic Heart Failure Analysis and Registry in the Tohoku District-2 (CHART-2) Study (N=10,219). We aimed to develop a new risk score to predict AF onset using the CHART-2 database.
Results: At enrollment, 1,217 (22.6%) had AF. They were characterized, as compared with those without AF, by higher age (70.5 vs. 66.8 yrs.), lower estimated glomerular filtration rate (64.0 vs. 68.3 ml/min/1.73m2), higher brain natriuretic peptide levels (106 vs. 37.0 pg/ml) and lower LV ejection fraction (63.6 vs. 65.2 %) (all P<0.001). Patients with AF were more frequently treated with beta-blockers and diuretics, and less treated with renin-angiotensin system inhibitors and statins. During the median 3.1-year follow-up, 116 (2.8%) newly developed AF. AF at enrollment was associated with worse prognosis for both all-cause death and HF admission (adjusted hazard ratio (aHR) 1.31 and 1.74, P=0.027 and 0.001 for all-cause death and HF admission, respectively), while new AF was associated with HF admission (aHR 4.54,P<0.001) but not with all-cause death. We developed a new risk score that consisted of higher age, smoking, higher pulse pressure, lower eGFR, higher BNP, LV hypertrophy, left atrial and ventricular dilatation on echocardiography, which accurately stratified the risk for new AF onset (AUC 0.76) (Figure). Average annual incidence of new AF (/1000 patients) was 10, 53, and 177 with the risk score 0-3, 4-8, and 9-12, respectively (P<0.001).
Conclusions: AF is associated with worse prognosis in patients at high-risk for HF, where the new risk score may be useful to stratify the risk of new AF in those patients.
Author Disclosures: T. Yamauchi: None. Y. Sakata: None. M. Miura: None. T. Onose: None. K. Tsuji: None. R. Abe: None. T. Oikawa: None. S. Kasahara: None. K. Nochioka: None. J. Takahashi: None. T. Shiroto: None. S. Miyata: None. H. Shimokawa: Speakers Bureau; Modest; Daiichi-Sankyo, Bayer Yakuhin.
- © 2016 by American Heart Association, Inc.