The American journal of cardiology
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The incidence of heart failure (HF) hospitalization and its impact on long-term outcomes have not been well evaluated in contemporary patients with ST-segment elevation myocardial infarction (STEMI) after primary percutaneous coronary intervention (PCI). The Coronary Revascularization Demonstrating Outcome Study in Kyoto Acute Myocardial Infarction (AMI) Registry is a multicenter registry enrolling 5,429 consecutive patients with AMI undergoing PCI from 2005 to 2007. The present study population consisted of 3,682 patients with STEMI who underwent primary PCI within 24 hours of symptom onset and discharged alive. ⋯ By the landmark analysis at 1 year, the cumulative incidences of all-cause death and HF hospitalization beyond 1 year and up to 5 years were significantly higher in patients with HF hospitalization within 1 year of STEMI than in patients without (36.3% vs 10.1%, p <0.001, and 40.4% vs 4.3%, p <0.001, respectively). Even after adjusting for confounders, HF hospitalization within 1 year remained independently associated with a higher risk for death and HF hospitalization beyond 1 year (hazard ratio 1.64, 95% CI 1.02 to 2.52, p = 0.04 and HR 5.72, 95% CI 3.46 to 9.22, p <0.001, respectively). In conclusion, HF hospitalization within 1 year was independently associated with a higher risk for all-cause death and HF hospitalization beyond 1 year.
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Randomized Controlled Trial Multicenter Study
Gender Differences in the Risk of Adverse Outcomes in Patients With Atrial Fibrillation and Heart Failure With Preserved Ejection Fraction.
Atrial fibrillation (AF) is associated with an increased risk for adverse events in patients with heart failure with preserved ejection fraction (HFpEF), but it is currently unknown if gender differences in these outcomes exist. To explore this hypothesis, we examined gender differences in the associations of AF with adverse outcomes in 3,385 (mean age 69 ± 9.6 years, 49% male, 89% white) patients with HFpEF from the Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist Trial. Baseline AF cases were identified by self-reported history, medical record review, and baseline electrocardiogram data. ⋯ The association between AF and hospitalization was stronger in women (HR 1.63, 95% CI 1.40 to 1.91) than men (HR 1.37, 95% CI 1.18 to 1.58; p-interaction = 0.032). Although significant interactions were not observed for the other outcomes, we appreciated that the risk estimates were higher for women compared with men. In conclusion, AF increases the risk for adverse cardiovascular outcomes in patients with HFpEF, and the presence of this arrhythmia in women possibly is associated with a greater risk for adverse events than men.
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Randomized Controlled Trial Multicenter Study
Effect of Atrial Fibrillation on Mortality, Stroke Risk, and Quality-of-Life Scores in Patients With Heart Failure (from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation [ORBIT-AF]).
The degree to which clinical outcomes are worsened in patients with atrial fibrillation (AF) with heart failure (HF) compared with those without HF is not well described. This study aimed to determine the impact of HF on clinical outcomes in patients with AF. We analyzed data from Outcomes Registry for Better Informed Treatment of Atrial Fibrillation, a national registry of 10,135 patients with AF to determine associations between HF and left ventricular ejection fraction (LVEF) and outcomes, including stroke, mortality, and hospitalization using Cox multivariable modeling. ⋯ AFEQT overall score was significantly lower (76.9 vs 83.3, p <0.0001) in patients with HF. In conclusion, HF was associated with increased risk of death and hospitalization and worse quality of life, but similar rates of thromboembolism regardless of LVEF among patients with AF. These findings highlight the need to develop therapeutic strategies targeting functional status and survival for patients with HF and AF.