Inkelaar, BSc, F.D.J. (2020) Patients with new-onset heart failure and concomitant atrial fibrillation more often improve in left ventricular ejection fraction after protocolized up-titration of guideline directed medical therapy as compared to patients in sinus rhythm. thesis, Medicine.
Full text available on request.Abstract
Introduction. Atrial fibrillation (AF) in patients with established heart failure (HF) is associated with worse outcomes. Little is known about the consequences of AF in patients with new-onset HF. We sought to investigate clinical characteristics and prognosis of AF patients with new-onset HF, and the effects of up-titration of guideline directed medical therapy (GDMT). Methods. We studied 607 new-onset (<3 months) HF patients from a specialized HF clinic in the Netherlands. AF was defined on the rhythm at baseline electrocardiogram (ECG). Heart failure with reduced ejection fraction (HFrEF) was defined as left ventricular ejection fraction (LVEF) ≤40% and heart failure with preserved ejection fraction as LVEF ³50%. Results. At baseline, 420 patients had sinus rhythm and 187 patients had AF. Patients with AF were older, more symptomatic, and had more often valvular heart disease or tachycardiomyopathy as primary aetiology of HF. In patients with HFrEF, baseline NT-proBNP was 34% higher in patients with AF, while in patients with HFpEF baseline NT-proBNP was 290% higher (p<0.001). Up-titration of GDMT was similar between patients with and without AF, except for a higher use of diuretics in patients with AF (85% versus 59%, p<0.001). Improvement in LVEF of ≥5% occurred more frequently in patients with AF than in those in sinus rhythm (61% versus 49%, p=0.030) and risks for the combined endpoint of death and/or HF hospitalization were similar. Conclusion. Except more diuretic use in patients with AF, up-titration of GDMT was similar, but improvement in LVEF was more frequent in patients with AF.
| Item Type: | Thesis (UNSPECIFIED) |
|---|---|
| Supervisor name: | Prof. dr. Voors, A.A. and Drs. Santema, B.T. |
| Faculty: | Medical Sciences |
| Date Deposited: | 01 Nov 2023 12:40 |
| Last Modified: | 01 Nov 2023 12:40 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/3721 |
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