Atrial fibrillation and risk of clinical events in chronic heart failure with and without left ventricular systolic dysfunction - Results from the Candesartan in Heart failure-Assessment of Reduction in Mortality and Morbidity (CHARM) program
Atrial fibrillation and risk of clinical events in chronic heart failure with and without left ventricular systolic dysfunction - Results from the Candesartan in Heart failure-Assessment of Reduction in Mortality and Morbidity (CHARM) program
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DOI：
10.1016/j.jacc.2006.01.060
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发表时间：
2006-05-16
影响因子：
24
通讯作者：
Pfeffer, Marc A.
中科院分区：
文献类型：
--
作者：
Olsson, Lars G.;Swedberg, Karl;Pfeffer, Marc A.
目的：我们在坎地沙坦治疗心力衰竭-死亡率和发病率降低评估（CHARM）项目中评估与心房颤动（AF）相关的不良心血管（CV）结局的风险，该项目招募了慢性心力衰竭（CHF）和大范围射血分数（EFs）患者。背景：心房颤动与CHF和EF降低患者心血管不良结局的风险增加相关。保留左心室射血分数（PEF）的CHF患者发生房颤的风险尚不清楚。方法共有7599例有症状的CHF患者被随机分为坎地沙坦组和安慰剂组。根据基线EF（40%）将患者分为低EF组和保留EF组。主要结局是心血管死亡或因心衰恶化而住院，以及全因死亡率。中位随访时间为37.7个月。结果：低EF组和PEF组分别有670例（17%）和478例（19%）患者在基线时发生房颤。无论基线EF如何，房颤都预示着心血管疾病发病率和死亡率的高风险。AF和低EF的患者发生不良CV结局的绝对风险最高。然而，与低EF患者相比，AF与PEF患者主要结局的相对增加风险相关：风险比分别为1.72（95%可信区间[Cl] 1.45至2.06）和1.29 （95% CI 1.14至1.46）。全因死亡率的风险也是如此。坎地沙坦的治疗效果与基线节律无关。结论：心房颤动与CHF患者心血管结局风险增加和EF或PEF降低相关。坎地沙坦对结果的改善与基线节律无关。[J] journal of Cardiology; 2006;47:1997-2004] (c) 2006 by American College of Cardiology Foundation
OBJECTIVES We assessed the risk of adverse cardiovascular (CV) outcomes associated with atrial fibrillation (AF) in the Candesartan in Heart failure-Assessment of Reduction in Mortality and morbidity (CHARM) program, which enrolled patients with chronic heart failure (CHF) and a broad range of ejection fractions (EFs).BACKGROUND Atrial fibrillation is associated with an increased risk of adverse CV outcomes in patients with CHF and reduced EF. The risk of AF in patients with CHF and preserved left ventricular ejection fraction (PEF) is unknown.METHODS A total of 7,599 patients with symptomatic CHF were randomized to candesartan or placebo. Patients were divided by baseline EF ( 40%) in low or preserved EF groups. Major outcomes were cardiovascular death or hospitalization for worsening heart failure, and all-cause mortality. Median follow-up was 37.7 months.RESULTS A total of 670 (17%) patients in the low EF group and 478 (19%) in the PEF group had AF at baseline. Atrial fibrillation predicted a high risk of cardiovascular morbidity and mortality regardless of baseline EF. Patients with AF and low EF had the highest absolute risk for adverse CV outcomes. However, AF was associated with greater relative increased risk of the major outcomes in patients with PEF than in patients with low EF: hazard ratio 1.72 (95% confidence interval [Cl] 1.45 to 2.06) versus 1.29 (95% CI 1.14 to 1.46), respectively. The same was true for the risk of all-cause mortality. Candesartan was associated with similar treatment effects regardless of baseline rhythm.CONCLUSIONS Atrial fibrillation is associated with an increased risk of CV outcomes in patients with CHF and either reduced EF or PEF. Candesartan improved outcomes similarly regardless of baseline rhythm. (J Am Coll Cardiol 2006;47:1997-2004) (c) 2006 by the American College of Cardiology Foundation.