RISK INCREASING PREDICTORS OF DEATH FROM ALL CAUSES IN PATIENTS WITH A PERSISTENT ATRIAL FIBRILLATION OF NON-VALVULAR ETIOLOGY
DOI:
https://doi.org/10.11603/2415-8798.2018.2.9207Keywords:
death from all causes, permanent atrial fibrillation, heart failure, chronic obstructive pulmonary disease.Abstract
Atrial fibrillation (AF) is one of the most common arrhythmias in the heart, and it is a potent risk factor for the development of cardiovascular disease (CVD) and death from all causes.
The aim of the study – to identify predictors of the risk of death from all causes in patients with a persistent form of atrial fibrillation (PFTF) of non-valvular etiology.
Materials and Methods. We performed a retrospective analysis of 146 histories of diseases of patients with non-valvular PA F with inpatient treatment, 16 patients died at the time of the study, which were subject to further analysis. For heart rate controll, the therapy of BB (bisoprolol and carvedilol) was performed. The endpoint of the study was death from all causes. An assessment of heart rate control on ECG data and echocardiographic parameters were performed at the time of discharge.
Results and Discussion. In the group of patients undergoing analysis, strict heart rate control was prevalent. There was an increase in the size of both atriums, the volume of LV , its moderate hypertrophy, moderate regurgitation on the mitral and tricuspidal valve according to the echocardiography data. At the time of discharge, the dosage for heart rate controll was: bisoprolol – (5.6±2) mg, carvedilol – (20±2.3) mg, digoxin – (0.19±0.07) mg. Then we determined the predictors risk increasing of death from all causes. Onefactor regression analysis revealed that the risk of death from all causes among patients with PA F significantly increased with a history of COPD in patient anamnesis (p = 0.01), as well as increase in the NYHA functional class of HF on the scale for each unit (p = 0.046). In multivariate regression analysis, where indicators were selected using stepwise method, the risk of death from all causes in patients with PA F in the presence of COPD in patient anamnesis increased significantly when standardized by other risk factors (p=0.01).
Conclusions. Independent risk increasing predictors of the death from all causes in patients with PA F non-valvular etiology are the presence of COPD in patient anamnesis and the increasing of NYHA functional class HF. The death risk from all causes in these patients significantly increases with the presence of COPD in patient anamnesis when standardized by other factors. The study complements the existing data on the importance of heart rate controll in patients with PA F and the correctness of the treatment concomitant HF. The obtained results are new and important for revealing the reasons of high mortality of this category of patients and ways of correction of their treatment.
References
Kokubo, Y. & Matsumoto, C. (2016). Traditional Cardiovascular Risk Factors for Incident Atrial Fibrillation. Circulation Journal, 80 (12), 2415-2422. DOI:10.1253/circj.cj-16-0919
Chugh, S.S., Havmoeller, R., Narayanan, K., Singh, D., Rienstra, M., Benjamin, E.J., ... Murray, C.J. (2013). Worldwide Epidemiology of Atrial Fibrillation: A Global Burden of Disease 2010 Study. Circulation, 129 (8), 837-847. DOI:10.1161/circulationaha.113.005119
Emdin, C.A., Wong, C.X., Hsiao, A.J., Altman, D.G., Peters, S.A., Woodward, M. & Odutayo, A.A. (2016). Atrial fibrillation as risk factor for cardiovascular disease and death in women compared with men: Systematic review and meta-analysis of cohort studies. Bmj, 532, h7013. doi:10.1136/bmj.h7013
Benjamin, E.J., Wolf, P.A., Dagostino, R.B., Silbershatz, H., Kannel, W.B. & Levy, D. (1998). Impact of Atrial Fibrillation on the Risk of Death : The Framingham Heart Study. Circulation, 98 (10), 946-952. DOI:10.1161/01.cir.98.10.946
Panaccio, M., Cummins, G., Wentworth, C., Lanes, S., Reynolds, S., Reynolds, M., ... Koren, A. (2015). A common data model to assess cardiovascular hospitalization and mortality in atrial fibrillation patients using administrative claims and medical records. Clinical Epidemiology, 7, 77-90. DOI:10.2147/clep.s64936
Chiang, C.E., Naditch-Brule, L., Murin, J., Goethals, M., Inoue, H., Oneill, J., ... Steg, P.G. (2012). Distribution and Risk Profile of Paroxysmal, Persistent, and Permanent Atrial Fibrillation in Routine Clinical Practice: Insight From the Real-Life Global Survey Evaluating Patients With Atrial Fibrillation International Registry. Circulation: Arrhythmia and Electrophysiology, 5 (4), 632-639. DOI:10.1161/circep.112.970749
Murin, J., Naditch-Brûlé, L., Brette, S., Chiang, C., O’Neill, J. & Steg, P.G. (2014). Clinical Characteristics, Management, and Control of Permanent vs. Nonpermanent Atrial Fibrillation: Insights from the RealiseAF Survey. PLoS ONE, 9 (1), е86443. DOI:10.1371/journal.pone.0086443
Keating, R.J., Gersh, B.J., Hodge, D.O., Weivoda, P.L., Patel, P.J., Hammill, S.C. & Shen, W. (2005). Effect of Atrial Fibrillation Pattern on Survival in a Community-Based Cohort. The American Journal of Cardiology, 96 (10), 1420-1424. DOI:10.1016/j.amjcard.2005.07.050
Ruigómez, A., Johansson, S., Wallander, M.,& Rodríguez, L.A. (2002). Risk of mortality in a cohort of patients newly diagnosed with chronic atrial fibrillation. BMC Cardiovascular Disorders, 2:5. DOI:10.1186/1471-2261-2-5
Steinberg, B.A., Kim, S., Thomas, L., Fonarow, G.C., Gersh, B.J., Holmqvist, F., ... Piccini, J.P. (2015). Increased Heart Rate Is Associated With Higher Mortality in Patients With Atrial Fibrillation (AF): Results From the Outcomes Registry for Better Informed Treatment of AF (ORBIT-AF). Journal of the American Heart Association, 4 (9), e002031. DOI:10.1161/jaha.115.002031
Ohsawa, M., Okayama, A., Okamura, T., Itai, K., Nakamura, M., Tanno, K., ... Ueshima, H. (2007). Mortality Risk Attributable to Atrial Fibrillation in Middle-Aged and Elderly People in the Japanese General Population. Circulation Journal, 71 (6), 814-819. DOI:10.1253/circj.71.814
Wan, H., Yang, Y., Zhu, J., Wang, J., Huang, B., Shao, X., & Zhang, H. (2015). Prognostic value of ventricular heart rate in patients with permanent atrial fibrillation and heart failure. International Journal of Cardiology, 182, 70-71. DOI:10.1016/j.ijcard.2014.12.120
Wan, H., Yang, Y., Zhu, J., Shao, X., Wang, J., Huang, B., & Zhang, H. (2015). The Prognostic Effects of Ventricular Heart Rate Among Patients With Permanent Atrial Fibrillation With and Without Coronary Artery Disease. Medicine, 94 (22), e920. DOI:10.1097/md.0000000000000920
Kirchhof, P., Benussi, S., Kotecha, D., Ahlsson, A., Atar, D., Casadei, B., ... Zeppenfeld, K. (2016). 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. European Heart Journal, 37 (38), 2893-2962. DOI:10.1093/eurheartj/ehw210
Ponikowski, P., Voors, A.A., Anker, S.D., Bueno, H., Cleland, J.G., Coats, A. J., ... Meer, P.V. (2016). 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. European Heart Journal, 37 (27), 2129-2200. DOI:10.1093/eurheartj/ehw128
Chao, T., Liu, C., Tuan, T., Chen, S., Wang, K., Lin, Y., ... Chen, S. (2015). Rate-Control Treatment and Mortality in Atrial Fibrillation CLINICAL PERSPECTIVE. Circulation, 132 (17), 1604-1612. DOI:10.1161/circulationaha.114.013709
Fauchier, L., Grimard, C., Pierre, B., Nonin, E., Gorin, L., Rauzy, B., ... Charbonnier, B. (2009). Comparison of Beta Blocker and Digoxin Alone and in Combination for Management of Patients With Atrial Fibrillation and Heart Failure. The American Journal of Cardiology, 103 (2), 248-254. DOI:10.1016/j.amjcard.2008.09.064
Cadrin-Tourigny, J., Shohoudi, A., Roy, D., Talajic, M., Tadros, R., Mondésert, B., ... Khairy, P. (2017). Decreased Mortality With Beta-Blockers in Patients With Heart Failure and Coexisting Atrial Fibrillation. JACC: Heart Failure, 5 (2), 99-106. DOI:10.1016/j.jchf.2016.10.015
Ramaswamy, K. (2003). Beta Blockers Improve Outcome in Patients with Heart Failure and Atrial Fibrillation: U.S. Carvedilol Study. Cardiac Electrophysiology Review, 7 (3), 229-232. DOI:10.1023/b:cepr.0000012388.85901.1c
Nielsen, P.B., Larsen, T.B., Gorst-Rasmussen, A., Skjøth, F., & Lip, G.Y. (2016). β-Blockers in Atrial Fibrillation Patients With or Without Heart FailureCLINICAL PERSPECTIVE. Circulation: Heart Failure, 9 (2), e002597. DOI:10.1161/circheartfailure.115.002597
Lang, R.M., Badano, L.P., Mor-Avi, V., Afilalo, J., Armstrong, A., Ernande, L., ... Voigt, J. (2015). Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Journal of the American Society of Echocardiography, 28 (1), 632-639. DOI:10.1016/j.echo.2014.10.003
Rudski, L.G., Lai, W.W., Afilalo, J., Hua, L., Handschumacher, M.D., Chandrasekaran, K., ... Schiller, N.B. (2010). Guidelines for the Echocardiographic Assessment of the Right Heart in Adults: A Report from the American Society of Echocardiography. Journal of the American Society of Echocardiography, 23 (7), 685-713. DOI:10.1016/j.echo.2010.05.010
Bossone, E., D’Andrea, A., D’Alto, M., Citro, R., Argiento, P., Ferrara, F., ... Naeije, R. (2013). Echocardiography in Pulmonary Arterial Hypertension: From Diagnosis to Prognosis. Journal of the American Society of Echocardiography, 26 (1), 1-14. DOI:10.1016/j.echo.2012.10.009
Nishimura, R.A., Otto, C.M., Bonow, R.O., Carabello, B.A., Erwin, J.P., Guyton, R.A., ... Thomas, J.D. (2014). 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary. Journal of the American College of Cardiology, 63 (22), 2438-2488. DOI:10.1016/j.jacc.2014.02.537
Taillandier, S., Bernard, A.B., Lallemand, B., Simeon, E., Pericart, L., Clementy, N., ... Fauchier, L. (2014). Prognosis in Patients Hospitalized With Permanent and Nonpermanent Atrial Fibrillation in Heart Failure. The American Journal of Cardiology, 113 (7), 1189-1195. DOI:10.1016/j.amjcard.2013.12.024
Middlekauff, H.R., Stevenson, W.G. & Stevenson, L.W. (1991). Prognostic significance of atrial fibrillation in advanced heart failure. A study of 390 patients. Circulation, 84 (1), 40-48. DOI:10.1161/01.cir.84.1.40
Proietti, M., Laroche, C., Drozd, M., Vijgen, J., Cozma, D.C., Drozdz, J., ... Lip, G.Y. (2016). Impact of chronic obstructive pulmonary disease on prognosis in atrial fibrillation: A report from the EURObservational Research Programme Pilot Survey on Atrial Fibrillation (EORP-AF) General Registry. American Heart Journal, 181, 83-91. DOI:10.1016/j.ahj.2016.08.011
Fung, J.W., Yu, C.M., Kum, L.C., Yip, G.W. & Sanderson, J.E. (2003). Role of Beta-Blocker Therapy in Heart Failure and Atrial Fibrillation. Cardiac Electrophysiology Review, 7 (3), 236-242. DOI:10.1023/b:cepr.0000012390.43937.2c
Linssen, G.C., Rienstra, M., Jaarsma, T., Voors, A.A., Gelder, I.C., Hillege, H.L. & Veldhuisen, D.J. (2011). Clinical and prognostic effects of atrial fibrillation in heart failure patients with reduced and preserved left ventricular ejection fraction. European Journal of Heart Failure, 13 (10), 1111-1120. DOI:10.1093/eurjhf/hfr066
Parkash, R., Maisel, W.H., Toca, F.M. & Stevenson, W.G. (2005). Atrial fibrillation in heart failure: High mortality risk even if ventricular function is preserved. American Heart Journal, 150 (4), 701-706. DOI:10.1016/j.ahj.2004.12.014
Mamas, M.A., Caldwell, J.C., Chacko, S., Garratt, C.J., Fath-Ordoubadi, F. & Neyses, L. (2009). A meta-analysis of the prognostic significance of atrial fibrillation in chronic heart failure. European Journal of Heart Failure, 11 (7), 676-683. DOI:10.1093/eurjhf/hfp085
Shotan, A., Garty, M., Blondhein, D.S., Meisel, S.R., Lewis, B.S., Shochat, M., ... Gottlieb, S. (2009). Atrial fibrillation and long-term prognosis in patients hospitalized for heart failure: Results from heart failure survey in Israel (HFSIS). European Heart Journal, 31 (3), 309-317. DOI:10.1093/eurheartj/ehp422
Jhund, P.S., Macintyre, K., Simpson, C.R., Lewsey, J.D., Stewart, S., Redpath, A., ... Mcmurray, J.J. (2009). Long-Term Trends in First Hospitalization for Heart Failure and Subsequent Survival Between 1986 and 2003: A Population Study of 5.1 Million People. Circulation, 119 (4), 515-523. DOI:10.1161/circulationaha.108.812172
Ahmed, A., Aronow, W.S. & Fleg, J.L. (2006). Higher New York Heart Association classes and increased mortality and hospitalization in patients with heart failure and preserved left ventricular function. American Heart Journal, 151 (2), 444-450. DOI:10.1016/j.ahj.2005.03.066
Proietti, M., Laroche, C., Drozd, M., Vijgen, J., Cozma, D.C., Drozdz, J., ... Lip, G.Y. (2016). Impact of chronic obstructive pulmonary disease on prognosis in atrial fibrillation: A report from the EURObservational Research Programme Pilot Survey on Atrial Fibrillation (EORP-AF) General Registry. American Heart Journal, 181, 83-91. DOI:10.1016/j.ahj.2016.08.011
Andersson, T., Magnuson, A., Bryngelsson, I., Frøbert, O., Henriksson, K.M., Edvardsson, N. & Poçi, D. (2013). All-cause mortality in 272 186 patients hospitalized with incident atrial fibrillation 1995–2008: A Swedish nationwide long-term case–control study. European Heart Journal, 34 (14), 1061-1067. DOI:10.1093/eurheartj/ehs469
Durheim, M.T., Cyr, D.D., Lopes, R.D., Thomas, L.E., Tsuang, W.M., Gersh, B.J., ... Al-Khatib, S.M. (2016). Chronic obstructive pulmonary disease in patients with atrial fibrillation: Insights from the ARISTOTLE trial. International Journal of Cardiology, 202, 589-594. DOI:10.1016/j.ijcard.2015.09.062
Huang, B., Yang, Y., Zhu, J., Liang, Y., Zhang, H., Tian, L., ... Wang, J. (2014). Clinical Characteristics and Prognostic Significance of Chronic Obstructive Pulmonary Disease in Patients With Atrial Fibrillation: Results From a Multicenter Atrial Fibrillation Registry Study. Journal of the American Medical Directors Association, 15 (8), 576-581. DOI:10.1016/j.jamda.2014.04.009
Kubota, Y., Asai, K., Furuse, E., Nakamura, S., Murai, K., Tsukada, Y.T. & Shimizu, W. (2015). Impact of β-blocker selectivity on long-term outcomes in congestive heart failure patients with chronic obstructive pulmonary disease. International Journal of Chronic Obstructive Pulmonary Disease, 10 (21), 515-523. DOI:10.2147/copd.s79942
Lainscak M., Hodoscek L.M., Düngen H.D., Rauchhaus, M., Doehner W., Anker S.D. & von Haehling, S. (2009). The burden of chronic obstructive pulmonary disease in patients hospitalized with heart failure. Wien Klin. Wochenschr, 121 (9-10), 309-313.
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