Heart failure & cardiomyopathies
Atrial Fibrillation can adversely impact Heart Failure with Preserved Ejection Fraction by its association with Heart Failure Progression and Mortality: A Post-Hoc Propensity Score–Matched Analysis of the TOPCAT Americas Trial
Authors' conclusion
Prevalent AF can be an independent risk factor for adverse CV outcomes by its selective association with worsening HF, HFH, and PFD in HFpEF. Prevalent AF was not associated with excess sudden death risk in HFpEF. Atrial fibrillation was also associated with HF progression in early symptomatic HFpEF and PFD in advanced HFpEF.
Study context
- Population
- Patients with HFpEF in the TOPCAT Americas trialPropensity score-matched (PSM) cohorts
- Comparison
- Prevalent atrial fibrillation (AF) vs no AF
- Any AFn = 584
- AF on electrocardiogram (ECG)n = 418
- Primary endpoint
- Cardiovascular (CV) death, cause-specific mortality and HF morbidity
- Follow-up
- Mean 2.9 years
Methodological detailspropensity-score matched
- Propensity-score matched
Primary result
As reported in the abstract
Hazard ratio (95% CI)P value
Any AFvs No AFCV hospitalization
1.33(1.11–1.61)
P = 0.003Any AFvs No AFHF hospitalization
1.44(1.12–1.86)
P = 0.004Any AFvs No AFpump failure death
1.95(1.05–3.62)
P = 0.035Any AFvs No AFHF progression NYHA I/II to III/IV
1.30(1.04–1.62)
P = 0.02AF on ECGvs Sinus rhythmCV death
1.46(1.02–2.09)
P = 0.039AF on ECGvs Sinus rhythmpump failure death
2.21(1.11–4.40)
P = 0.024AF on ECGvs Sinus rhythmCV hospitalization
1.37(1.09–1.72)
P = 0.006AF on ECGvs Sinus rhythmHF hospitalization
1.65(1.22–2.23)
P = 0.001Further findings
Pump failure death in New York Heart Association (NYHA) III/IV heart failure (HF) (subgroup)
- Both Any AF and AF on ECG associated with pump failure death
Original publication
Atrial Fibrillation can adversely impact Heart Failure with Preserved Ejection Fraction by its association with Heart Failure Progression and Mortality: A Post-Hoc Propensity Score–Matched Analysis of the TOPCAT Americas Trial. Europace. Published 20 April 2023. doi:10.
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