Atrial fibrillation or flutter on initial electrocardiogram is associated with worse outcomes in patients admitted for worsening heart failure with reduced ejection fraction: Findings from the EVEREST Trial

Robert J. Mentz, Matthew J. Chung, Mihai Gheorghiade, Peter Pang, Mary J. Kwasny, Andrew P. Ambrosy, Muthiah Vaduganathan, Christopher M. O'Connor, Karl Swedberg, Faiez Zannad, Marvin A. Konstam, Aldo P. Maggioni

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Background: Heart failure (HF) complicated by atrial fibrillation/flutter (AF/AFL) is associated with worse outcomes. However, the clinical profile and outcomes of patients following hospitalization for HF with AF/AFL on initial electrocardiogram (ECG) has not been well studied. Methods: EVEREST was a randomized trial of vasopressin-2 receptor blockade, in addition to standard therapy, in 4133 patients hospitalized with HF with ejection fraction ≤40%. A post hoc analysis was performed comparing the clinical characteristics and outcomes [all-cause mortality and cardiovascular mortality/HF hospitalization] of patients with AF/AFL versus sinus rhythm (SR) on baseline ECG, which were centrally analyzed. Times to events were compared using log-rank tests and Cox regression models. Results: Of the 4133 patients, 1195 (29%) were classified with AF/AFL and 2071(50%) with SR. The remaining patients (21%) were excluded because ECGs were unavailable (n = 106), rhythm was paced (n = 727), or junctional/other supraventricular (n = 34). AF/AFL patients were older, with increased weight, faster heart rate, higher blood urea nitrogen, and natriuretic peptide levels compared to SR patients. Anticoagulation was prescribed in 67% of AF/AFL patients on discharge. AF/AFL patients were less likely to receive β-blockers or angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (all P

Original languageEnglish (US)
JournalAmerican Heart Journal
Volume164
Issue number6
DOIs
StatePublished - Dec 2012
Externally publishedYes

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Atrial Flutter
Atrial Fibrillation
Electrocardiography
Heart Failure
Hospitalization
Vasopressin Receptors
Natriuretic Peptides
Mortality
Patient Discharge
Angiotensin Receptor Antagonists
Blood Urea Nitrogen
Proportional Hazards Models
Angiotensin-Converting Enzyme Inhibitors
Heart Rate
Weights and Measures

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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Atrial fibrillation or flutter on initial electrocardiogram is associated with worse outcomes in patients admitted for worsening heart failure with reduced ejection fraction : Findings from the EVEREST Trial. / Mentz, Robert J.; Chung, Matthew J.; Gheorghiade, Mihai; Pang, Peter; Kwasny, Mary J.; Ambrosy, Andrew P.; Vaduganathan, Muthiah; O'Connor, Christopher M.; Swedberg, Karl; Zannad, Faiez; Konstam, Marvin A.; Maggioni, Aldo P.

In: American Heart Journal, Vol. 164, No. 6, 12.2012.

Research output: Contribution to journalArticle

Mentz, Robert J. ; Chung, Matthew J. ; Gheorghiade, Mihai ; Pang, Peter ; Kwasny, Mary J. ; Ambrosy, Andrew P. ; Vaduganathan, Muthiah ; O'Connor, Christopher M. ; Swedberg, Karl ; Zannad, Faiez ; Konstam, Marvin A. ; Maggioni, Aldo P. / Atrial fibrillation or flutter on initial electrocardiogram is associated with worse outcomes in patients admitted for worsening heart failure with reduced ejection fraction : Findings from the EVEREST Trial. In: American Heart Journal. 2012 ; Vol. 164, No. 6.
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abstract = "Background: Heart failure (HF) complicated by atrial fibrillation/flutter (AF/AFL) is associated with worse outcomes. However, the clinical profile and outcomes of patients following hospitalization for HF with AF/AFL on initial electrocardiogram (ECG) has not been well studied. Methods: EVEREST was a randomized trial of vasopressin-2 receptor blockade, in addition to standard therapy, in 4133 patients hospitalized with HF with ejection fraction ≤40{\%}. A post hoc analysis was performed comparing the clinical characteristics and outcomes [all-cause mortality and cardiovascular mortality/HF hospitalization] of patients with AF/AFL versus sinus rhythm (SR) on baseline ECG, which were centrally analyzed. Times to events were compared using log-rank tests and Cox regression models. Results: Of the 4133 patients, 1195 (29{\%}) were classified with AF/AFL and 2071(50{\%}) with SR. The remaining patients (21{\%}) were excluded because ECGs were unavailable (n = 106), rhythm was paced (n = 727), or junctional/other supraventricular (n = 34). AF/AFL patients were older, with increased weight, faster heart rate, higher blood urea nitrogen, and natriuretic peptide levels compared to SR patients. Anticoagulation was prescribed in 67{\%} of AF/AFL patients on discharge. AF/AFL patients were less likely to receive β-blockers or angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (all P",
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T2 - Findings from the EVEREST Trial

AU - Mentz, Robert J.

AU - Chung, Matthew J.

AU - Gheorghiade, Mihai

AU - Pang, Peter

AU - Kwasny, Mary J.

AU - Ambrosy, Andrew P.

AU - Vaduganathan, Muthiah

AU - O'Connor, Christopher M.

AU - Swedberg, Karl

AU - Zannad, Faiez

AU - Konstam, Marvin A.

AU - Maggioni, Aldo P.

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AB - Background: Heart failure (HF) complicated by atrial fibrillation/flutter (AF/AFL) is associated with worse outcomes. However, the clinical profile and outcomes of patients following hospitalization for HF with AF/AFL on initial electrocardiogram (ECG) has not been well studied. Methods: EVEREST was a randomized trial of vasopressin-2 receptor blockade, in addition to standard therapy, in 4133 patients hospitalized with HF with ejection fraction ≤40%. A post hoc analysis was performed comparing the clinical characteristics and outcomes [all-cause mortality and cardiovascular mortality/HF hospitalization] of patients with AF/AFL versus sinus rhythm (SR) on baseline ECG, which were centrally analyzed. Times to events were compared using log-rank tests and Cox regression models. Results: Of the 4133 patients, 1195 (29%) were classified with AF/AFL and 2071(50%) with SR. The remaining patients (21%) were excluded because ECGs were unavailable (n = 106), rhythm was paced (n = 727), or junctional/other supraventricular (n = 34). AF/AFL patients were older, with increased weight, faster heart rate, higher blood urea nitrogen, and natriuretic peptide levels compared to SR patients. Anticoagulation was prescribed in 67% of AF/AFL patients on discharge. AF/AFL patients were less likely to receive β-blockers or angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (all P

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