Prognostic relevance of atrial fibrillation in patients with chronic heart failure on long-term treatment with betablockers: Results from COMET
Prognostic relevance of atrial fibrillation in patients with chronic heart failure on long-term treatment with betablockers: Results from COMET
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DOI：
10.1093/eurheartj/ehi166
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发表时间：
2005-07-01
影响因子：
39.3
通讯作者：
Poole-Wilson, P
中科院分区：
文献类型：
--
作者：
Swedberg, K;Olsson, LG;Poole-Wilson, P
目标心房。慢性心力衰竭（CHF）患者中常见纤颤。我们分析了一个大的队列中的慢性心力衰竭患者在治疗与β-blocker.Methods和结果在COMET，3029例CHF患者随机卡维地洛或酒石酸美托洛尔，并遵循平均58个月的房颤相关的风险。我们分析了基线心电图上房颤与无房颤的其他结局的预后相关性以及随访期间新发房颤的影响。使用考克斯回归模型进行多变量分析，其中10个基线协变量与研究治疗分配一起输入。600例患者（19.8%）在基线时患有房颤。这些患者年龄较大（65岁vs. 61岁），包括更多男性（88 vs. 78%），症状更严重[纽约心脏协会（NYHA）分级更高]，心力衰竭持续时间更长（P < 0.0001）。心房房颤与死亡率显著增加相关[相对危险度（RR）1.29：95%CI 1.12-1.48; P < 0.0001]，（RR 1.25：CI 1.13-1.38）和心血管死亡或因心力衰竭恶化住院（RR 1.34：CI 1.20-1.52），均P < 0.0001。通过多变量分析，房颤不再独立预测死亡率。卡维地醇对死亡率的有益影响仍然显著（RR 0.836：CI 0.74-0.94; P = 0.0042）。在一项时间依赖性分析中，随访期间新发房颤（n = 580）与随后死亡的风险显著增加相关（RR 1.90：Cl 1.54-2.35; P < 0.0001），而不考虑治疗分配和NYHA分级的变化。结论在CHF中，房颤显著增加死亡和心力衰竭住院的风险，但在调整其他预后预测因素后，不是死亡率的独立危险因素。与美托洛尔相比，卡维地洛治疗对房颤患者有额外的益处。长期接受β受体阻滞剂治疗的患者新发心房纤颤与随后死亡率和发病率风险显著增加相关。
Aims Atrial. fibrillation is common in patients with chronic heart failure (CHF). We analysed the risk associated with atrial fibrillation in a large cohort of patients with chronic heart failure at treated with a beta-blocker.Methods and results In COMET, 3029 patients with CHF were randomized to carvedilol or metoprolol tartrate and followed for a mean of 58 months. We analysed the prognostic relevance on other outcomes of atrial fibrillation on the baseline electrocardiogram compared with no atrial fibrillation and the impact of new onset atrial fibrillation during follow-up. A multivariate analysis was performed using a Cox regression model where 10 baseline covariates were entered together with study treatment allocation. Six hundred patients (19.8%) had atrial fibrillation at baseline. These patients were older (65 vs. 61 years), included more men (88 vs.78%), had more severe symptoms [higher New York Heart Association (NYHA) class] and a longer duration of heart failure (at[ P < 0.0001). Atrial. fibrillation was associated with significantly increased mortality [relative risk (RR) 1.29: 95% CI 1.12-1.48; P < 0.0001], higher all-cause death or hospitalization (RR 1.25: CI 1.13-1.38), and cardiovascular death or hospitalization for worsening heart failure (RR 1.34: CI 1.20-1.52), both P < 0.0001. By muitivariable analysis, atrial fibrillation no longer independently predicted mortality. Beneficial effects on mortality by carveditol remained significant (RR 0.836: Cl 0.74-0.94; P = 0.0042). New onset atrial fibrillation during follow-up (n = 580) was associated with significant increased risk for subsequent death in a time-dependent analysis (RR 1.90: Cl 1.54-2.35; P < 0.0001) regardless of treatment allocation and changes in NYHA class.Conclusion In CHF, atrial fibrillation significantly increases the risk for death and heart failure hospitalization, but is not an independent risk factor for mortality after adjusting for other predictors of prognosis. Treatment with carvedilol compared with metoprotol offers additional benefits among patients with atria[ fibrillation. Onset of new atria( fibrillation in patients on long-term beta-blocker therapy is associated with significant increased subsequent risk of mortality and morbidity.