Factors associated with disease progression in patients with atrial fibrillation and heart failure anticoagulated with rivaroxaban.

Autor: Manito N; Cardiology Department, Hospital Universitario de Bellvitge, Barcelona, Spain., Cepeda-Rodrigo JM; Department of Internal Medicine, Hospital Vega Baja, Orihuela, Spain., Farré N; Cardiology Department, Hospital del Mar, Barcelona, Spain., Castillo Orive M; Cardiology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain., Galve E; Consulta cardiología Galve Basilio, Barcelona, Spain., Jiménez-Candil J; Cardiology Department, IBSAL-Hospital Universitario de Salamanca, Universidad de Salamanca, CIBER-CV, Salamanca, Spain., García-Pinilla JM; Cardiology Department, Hospital Universitario Virgen de la Victoria, Málaga, Spain.; Instituto de Investigación Biomédica de Málaga-Plataforma BIONAND, Málaga, Spain.; Ciber-Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain.; Department of Medicine and Dermatology, Universidad de Málaga, Málaga, Spain., López Sánchez ES; Clínica Cardiología Vera, Almería, Spain., Rafols C; Medical Department, Bayer Hispania, Barcelona, Spain., Gómez Doblas JJ; Cardiology Department, Hospital Universitario Virgen de la Victoria, Málaga, Spain.; Instituto de Investigación Biomédica de Málaga-Plataforma BIONAND, Málaga, Spain.; Ciber-Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain.; Department of Medicine and Dermatology, Universidad de Málaga, Málaga, Spain.
Jazyk: angličtina
Zdroj: Clinical cardiology [Clin Cardiol] 2024 Feb; Vol. 47 (2), pp. e24189. Date of Electronic Publication: 2023 Nov 29.
DOI: 10.1002/clc.24189
Abstrakt: Background: Patients with atrial fibrillation (AF) and heart failure (HF) have a high risk of thromboembolism and other outcomes and anticoagulation is recommended.
Hypothesis: This study was aimed to explore the risk factors associated with HF worsening in patients with AF and HF taking rivaroxaban in Spain.
Methods: Multicenter, prospective, observational study that included adults with AF and chronic HF, receiving rivaroxaban ≥4 months before entering. HF worsening was defined as first hospitalization or emergency visit because of HF exacerbation.
Results: A total of 672 patients from 71 Spanish centers were recruited, of whom 658 (97.9%) were included in the safety analysis and 552 (82.1%) in the per protocol analysis. At baseline, mean age was 73.7 ± 10.9 years, 64.9% were male, CHA 2 DS 2 -VASc was 4.1 ± 1.5, HAS-BLED was 1.6 ± 0.9% and 51.3% had HF with preserved ejection fraction. After 24 months of follow-up, 24.9% of patients developed HF worsening, 11.6% died, 2.9% had a thromboembolic event, 3.1% a major bleeding, 0.5% an intracranial bleeding and no patient had a fatal hemorrhage. Older age, the history of chronic obstructive pulmonary disease, the previous use of vitamin K antagonists, and restrictive or infiltrative cardiomyopathies, were independently associated with HF worsening. Only 6.9% of patients permanently discontinued rivaroxaban treatment.
Conclusions: Approximately one out of four patients with HF and AF treated with rivaroxaban developed a HF worsening episode after 2 years of follow-up. The identification of those factors that increase the risk of HF worsening could be helpful in the comprehensive management of this population.
(© 2023 The Authors. Clinical Cardiology published by Wiley Periodicals, LLC.)
Databáze: MEDLINE
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