*For medical professionals only
“img class=”responsive ” sizes=”(min-width: 320px) 320px, 100vw” src=”https://mmbiz.qpic.cn/mmbiz_png/x5F5KAyDKw19I4VvcibrfNia7lD1fial5KribXqZxjxMxtoc3ichKKz6ib3w5kJias8QNRBYGn80MM0AxEgOvRLib>p>width=”6400″ >Atrial fibrillation and flutter (AFF) are common in patients with heart failure with preserved ejection fraction (HFpEF), with an incidence ranging from 5% to 32%. Increased risk of adverse outcomes in HFpEF with atrial fibrillation.
In a post hoc analysis of the TOPCAT trial (NCT00094302), 43% of subjects had a history of AF or AFF at enrollment. AFF at enrollment was associated with an increased risk of the primary composite end point of cardiovascular death or hospitalization for heart failure (HF). Despite the elevated risk, none of these conditions appeared to alter the treatment effect of spironolactone, nor did spironolactone affect the development of new AFF after randomization, which is a predictor of early increased risk of adverse outcomes.
In the PARAMOUNT study, sacubitril/valsartan resulted in greater reductions in NT-proBNP at 12 weeks and at 36 weeks compared with valsartan Afterwards, the left atrial size can be reduced even more. These hypothetical conclusions The rationale for the phase 3 trial PARAGON-HF was to determine whether sacubitril/valsartan improves outcomes in patients with HFpEF.
JACC: Heart Failure recently published a study evaluating the association between AFF and outcomes in patients with HFpEF in the PARAGON-HF trial and whether AFF was altered Treatment effect of sacubitril/valsartan and whether sacubitril/valsartan affected the probability of new-onset AFF after randomization in patients without a known history of AFF enrolled in the PARAGON-HF trial.
Methods
A total of 4776 patients comprised 3 groups:< /p>
Patients with a history of AFF at entry (n = 1552; 33%),
with a history of AFF but no ECG at entry Patients with AFF (n = 1005; 21%),
, and neither (n = 2219, 46%).
We assessed outcomes in each group, response to sacubitril/valsartan, and The risk associated with AFF was first detected in patients without AFF.
The primary endpoints were heart failure hospitalization and cardiovascular death.
Results
Compared with patients without AFF AFF, history of AFF and electrocardiographic AFF were associated with adverse events for the primary endpoint
(hazard ratio [RR] 1.36, [95%CI] 1.12-1.65], RR 1.31 [1.11-1.54]).
Neither the history of AFF nor the AFF at the time of enrollment has changed the Shakuba song / The therapeutic effect of valsartan.
After randomization, AFF occurred in 12% of patients without AFF and was associated with a 2.8-fold increased risk for the primary outcome, but not sacubitril/valsartan. Impact.
Study Conclusions
History of AFF on admission, AFF appearance on electrocardiogram were associated with poor outcomes in this trial.
New-onset AFF was not affected by sacubitril/valsartan treatment, but was associated with an increased risk of subsequent outcomes, possibly A potential direction for future HFpEF trials.
Source:
Atrial Fibrillation in Heart Failure With Preserved Ejection Fraction: The PARAGON-HF Trial. J Am Coll Cardiol HF 2022; Epub. doi: 10.1016/j.jchf.2022.01.018
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