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Atrial fibrillation in Dutch chronic heart failure with reduced ejection fraction patients: the CHECK-HF registry

Session Poster Session 3

Speaker Jesse Feiko Veenis

Event : Heart Failure 2019

  • Topic : heart failure
  • Sub-topic : Chronic Heart Failure: Pharmacotherapy
  • Session type : Poster Session

Authors : J F Veenis (Rotterdam,NL), HP Brunner-La Rocca (Maastricht,NL), AW Hoes (Utrecht,NL), GCM Linssen (Twente,NL), JJ Brugts (Rotterdam,NL)

Authors:
J F Veenis1 , HP Brunner-La Rocca2 , AW Hoes3 , GCM Linssen4 , JJ Brugts1 , 1Erasmus MC, University Medical Center Rotterdam, Cardiology - Rotterdam - Netherlands (The) , 2Maastricht University Medical Centre (MUMC), Cardiology - Maastricht - Netherlands (The) , 3University Medical Center Utrecht - Utrecht - Netherlands (The) , 4Hospital Group Twente, Cardiology - Twente - Netherlands (The) ,

On behalf: CHECK-HF investigators

Citation:

Background/introduction: Atrial fibrillation (AF) is a common finding in chronic heart failure (HF) patients, associated with an increased risk of mortality and thromboembolic events. The ESC provides guidelines for both AF and HF, however information on the adherence to these guidelines in patients with both AF and HF is scarce.

Purpose: Evaluation of current HF therapy and adherence to the ESC HF Guidelines in patients with and without AF in the Netherlands.

Methods: The current analysis is part of a cross-sectional registry of 10,910 chronic HF patients at 34 Dutch outpatient clinics in the period of 2013 until 2016 (CHECK-HF). Demographic parameters, laboratory and echocardiographic values as well as medication use (type, dosage and frequency and total daily dose) were recorded.

Results: We studied 8,253 patients with HF with reduced ejection fraction (HFrEF), of which 2,109 (25.6%) had AF. Patients with AF were significantly older (76.8±9.2 vs. 70.7±12.2 years, p<0.01), were more often in NYHA III/IV (33.4% vs. 25.2% resp., p<0.01), and had more hypertension (44.3% vs. 38.3, p<0.01), diabetes (31.0% vs. 28.4%, p<0.01) and renal insufficiency (63.3% vs. 53.8%, p<0.01) compared to HFrEF patients without AF. 
HF medication use is presented in Table 1. HFrEF patients with AF receive more often beta-blockers, MRA and diuretics, and less often RAS-inhibitor. We observed a lower percentage of ICD, CRT and pacemaker in patients with AF.

Conclusion: In this large registry, we observed a lower prescription of RAS-inhibitors, and implantation of ICD, CRT and pacemaker, but a higher prescription of beta-blocker, MRA and diuretics in HFrEF patients with AF, compared to those without AF.

Unadjusted analysis

Age and gender adjusted analysis (OR [95% CI])

Multivariate analysis (OR [95% CI])*

Pharmacotherapy (n=8,120)

With AF

Without AF

p-value

Beta-blocker,%

81.7

79.7

0.04

1.26 [1.11-1.44]

1.33 [1.16-1.52]

RAS-inhibitors, %

76.1

83.1

<0.01

0.79 [0.70-0.90]

0.87 [0.77-0.99]

MRA, %

57.1

51.7

<0.01

1.33 [1.20-1.48]

1.37 [1.23-1.53]

Diuretics, %

89.7

80.6

<0.01

1.72 [1.47-2.01]

1.65 [1.40-1.95]

Device therapy (n=6,591)

ICD

15.4

35.7

<0.01

0.40 [0.34-0.46]

0.42 [0.36-0.49]

CRT

7.3

20.2

<0.01

0.32 [0.26-0.39]

0.31 [0.26-0.39]

Pacemaker

8.5

8.3

0.77

0.69 [0.56-0.85]

0.60 [0.49-0.75]

* Adjusted for age, gender, NYHA classification, LVEF, HR>70, hypertension, diabetes and renal insufficiency

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