Heart failure & cardiomyopathies
Up-Titration of Medication in Patients with New-Onset Heart Failure with and Without Atrial Fibrillation
Authors' conclusion
In patients with new-onset HF, up-titration to recommended doses of GDMT was similar in patients with and without AF, but was associated with a greater improvement in LVEF in patients with AF.
Study context
- Population
- Patients with new-onset HF (<3 months) from a specialized nurse-led HF clinic in the Netherlandspatients with new-onset HF
- Participants
- 607 patients
- Comparison
- Patients with new-onset HF with and without atrial fibrillation (AF)
- AFn = 187
- Sinus rhythmn = 420
- Outcome
- Baseline characteristics: age, ischaemic heart disease, N-terminal B-type natriuretic peptide
- Follow-up
- Baseline
Main finding
As reported in the abstract
- Patients with AF were older, less likely to have ischaemic heart disease and had higher baseline N-terminal B-type natriuretic peptide levels
- all P < 0.05
Further findings
LVEF at baseline · similar
P = 0.453
ACEi/ARB prescription · lower in patients with AF
P = 0.038
Use of diuretics · higher in patients with AF
P < 0.001
Up-titration to guideline-recommended target doses · after an up-titration period of 9 months
Beta-blocker
ACEi/ARB
MRA
LVEF improvement of ≥5% and ≥10% after up-titration · more common in patients with AF
≥5%
≥10%
- Up-titration to guideline-recommended target doses: beta-blocker P = 0.096
- Up-titration to guideline-recommended target doses: ACEi/ARB P = 0.098
- Up-titration to guideline-recommended target doses: MRA P = 0.125
- Left ventricular ejection fraction (LVEF) improvement of ≥5% and ≥10% after up-titration: ≥5%: P = 0.017
- LVEF improvement of ≥5% and ≥10% after up-titration: ≥10%: P = 0.043
Reasons for not further up-titrating to recommended target doses
- Consistent across patients with AF and sinus rhythm
Mortality and HF rehospitalization · 3 years
- Achieving target doses of ACEi/ARB and MRA therapies was associated with lower mortality and HF rehospitalization rates in both patients with AF and those in sinus rhythm
Original publication
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