Arrhythmias & electrophysiology
Heart Failure Risk Assessment Using Biomarkers in Patients With Atrial Fibrillation: Analysis From COMBINE-AF
Authors' conclusion
NT-proBNP, hs-cTnT, and GDF-15 contributed significantly and independently to the risk stratification for HF endpoints in patients with AF, with hs-cTnT being as important as NT-proBNP for HF risk stratification.
Study context
- Population
- Patients with atrial fibrillation (AF) in 3 randomised trials of direct oral anticoagulants (DOACs) vs warfarin (ARISTOTLE, ENGAGE AF-TIMI 48, RE-LY) with baseline biomarkers
- Participants
- 32,041 patients
- Comparison
- Biomarkers added to clinical model for heart failure (HF) risk stratification
- Outcome
- Composite of:
- Hospitalization for HF (HHF)
- CV death (CVD)
Methodological detailsCOMBINE-AF cohort, Cox regression adjusted for clinical factors, weighted quantile sum regression
- COMBINE-AF cohort
- Cox regression adjusted for clinical factors
- Weighted quantile sum regression
Pooled result
As reported in the abstract
CVD/HHF
- NT-proBNP, HR per 1 SD (adjusted for clinical variables and all biomarkers)
- 1.68 (95% CI: 1.59-1.77)
- High-sensitivity cardiac troponin T (hs-cTnT), HR per 1 SD (adjusted)
- 1.39 (95% CI: 1.33-1.44)
- GDF-15, HR per 1 SD (adjusted)
- 1.20 (95% CI: 1.15-1.25)
- C-index, clinical model vs clinical model + biomarkers
- 0.70 [95% CI: 0.69-0.71] to 0.77 [95% CI: 0.76-0.78]; likelihood ratio test, P < 0.001
- Contribution to risk assessment (weighted quantile sum): NT-proBNP vs hs-cTnT
- 38% and 41%
Further pooled results
Hospitalization for HF (HHF) and HF-related death, individually; subgroups by history of HF, AF pattern, reduced or preserved LVEF
- Results similar to cardiovascular death (CVD)/HHF
Original publication
Heart Failure Risk Assessment Using Biomarkers in Patients With Atrial Fibrillation: Analysis From COMBINE-AF. J Am Coll Cardiol. Published 2 September 2024. doi:10.
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