European Heart Journal Advance Access originally published online on March 14, 2005
European Heart Journal 2005 26(13):1303-1308; doi:10.1093/eurheartj/ehi166
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Prognostic relevance of atrial fibrillation in patients with chronic heart failure on long-term treatment with beta-blockers: results from COMET
1Department of Medicine, Sahlgrenska University Hospital/Östra, SE–416 85 Göteborg, Sweden
2Nottingham Clinical Research Group (NCRG), Nottingham, UK
3Department of Cardiology, University of Hull, Kingston upon Hull, UK
4Medical Clinic I, University Hospital, Aachen, Germany
5Department of Cardiology, La Pitié-salpétrière Hospital, Paris, France
6Cattedra di Cardiologia, Università di Brescia, Brescia, Italy
7Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark
8Imperial College London, UK
Received 2 September 2004; revised 18 November 2004; accepted 13 January 2005; online publish-ahead-of-print 14 March 2005.
* Corresponding author. Tel: + 46 31 343 4078; fax: + 46 31 258 933. E-mail address: karl.swedberg{at}hjl.gu.se
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 all 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 (all 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 multivariable analysis, atrial fibrillation no longer independently predicted mortality. Beneficial effects on mortality by carvedilol remained significant (RR 0.836: CI 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: CI 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 metoprolol offers additional benefits among patients with atrial fibrillation. Onset of new atrial fibrillation in patients on long-term beta-blocker therapy is associated with significant increased subsequent risk of mortality and morbidity.
Key Words: Chronic heart failure • Atrial fibrillation • Beta-blockers • Prognosis
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  E. Anter and D. J. Callans Pharmacological and Electrical Conversion of Atrial Fibrillation to Sinus Rhythm Is Worth the Effort Circulation, October 6, 2009; 120(14): 1436 - 1443. [Full Text] [PDF]
|
|
|
|
 |
|
 M. A. Mamas, J. C. Caldwell, S. Chacko, C. J. Garratt, F. Fath-Ordoubadi, and L. Neyses A meta-analysis of the prognostic significance of atrial fibrillation in chronic heart failure Eur J Heart Fail, July 1, 2009; 11(7): 676 - 683. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Anter, M. Jessup, and D. J. Callans Atrial Fibrillation and Heart Failure: Treatment Considerations for a Dual Epidemic Circulation, May 12, 2009; 119(18): 2516 - 2525. [Full Text] [PDF]
|
|
|
|
 |
|
 X. Du, T. Ninomiya, B. de Galan, E. Abadir, J. Chalmers, A. Pillai, M. Woodward, M. Cooper, S. Harrap, P. Hamet, et al. Risks of cardiovascular events and effects of routine blood pressure lowering among patients with type 2 diabetes and atrial fibrillation: results of the ADVANCE study Eur. Heart J., May 1, 2009; 30(9): 1128 - 1135. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. G.F. Cleland and D. Cullington Digoxin: Quo Vadis? Circ Heart Fail, March 1, 2009; 2(2): 81 - 85. [Full Text] [PDF]
|
|
|
|
 |
|
 J. E. Poole, G. W. Johnson, A. S. Hellkamp, J. Anderson, D. J. Callans, M. H. Raitt, R. K. Reddy, F. E. Marchlinski, R. Yee, T. Guarnieri, et al. Prognostic Importance of Defibrillator Shocks in Patients with Heart Failure N. Engl. J. Med., September 4, 2008; 359(10): 1009 - 1017. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Rivero-Ayerza, W. Scholte op Reimer, M. Lenzen, D. A.M.J. Theuns, L. Jordaens, M. Komajda, F. Follath, K. Swedberg, and J. G.F. Cleland New-onset atrial fibrillation is an independent predictor of in-hospital mortality in hospitalized heart failure patients: results of the EuroHeart Failure Survey Eur. Heart J., July 1, 2008; 29(13): 1618 - 1624. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Rusinaru, L. Leborgne, M. Peltier, and C. Tribouilloy Effect of atrial fibrillation on long-term survival in patients hospitalised for heart failure with preserved ejection fraction Eur J Heart Fail, June 1, 2008; 10(6): 566 - 572. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Buck, M. Rienstra, A. H. Maass, W. Nieuwland, D. J. Van Veldhuisen, and I. C. Van Gelder Cardiac resynchronization therapy in patients with heart failure and atrial fibrillation: importance of new-onset atrial fibrillation and total atrial conduction time Europace, May 1, 2008; 10(5): 558 - 565. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. G.F. Cleland, A. P. Coletta, A. T. Abdellah, D. Cullington, A. L. Clark, and A. S. Rigby Clinical trials update from the American Heart Association 2007: CORONA, RethinQ, MASCOT, AF-CHF, HART, MASTER, POISE and stem cell therapy Eur J Heart Fail, January 1, 2008; 10(1): 102 - 108. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H.-R. Neuberger, C. Mewis, D. J. van Veldhuisen, U. Schotten, I. C. van Gelder, M. A. Allessie, and M. Bohm Management of atrial fibrillation in patients with heart failure Eur. Heart J., November 1, 2007; 28(21): 2568 - 2577. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. G.F. Cleland, R. Shelton, N. Nikitin, S. Ford, L. Frison, and M. Grind Prevalence of markers of heart failure in patients with atrial fibrillation and the effects of ximelagatran compared to warfarin on the incidence of morbid and fatal events: A report from the SPORTIF III and V trials Eur J Heart Fail, June 1, 2007; 9(6-7): 730 - 739. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Corell, F. Gustafsson, M. Schou, J. Markenvard, T. Nielsen, and P. Hildebrandt Prevalence and prognostic significance of atrial fibrillation in outpatients with heart failure due to left ventricular systolic dysfunction Eur J Heart Fail, March 1, 2007; 9(3): 258 - 265. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. Olsson, M. A. Pfeffer, and K. Swedberg Reply J. Am. Coll. Cardiol., January 23, 2007; 49(3): 376 - 377. [Full Text] [PDF]
|
|
|
|
|
|
J. G.F. Cleland, A. P. Coletta, A. T. Abdellah, M. Nasir, N. Hobson, N. Freemantle, and A. L. Clark Clinical trials update from the American Heart Association 2006: OAT, SALT 1 and 2, MAGIC, ABCD, PABA-CHF, IMPROVE-CHF, and percutaneous mitral annuloplasty Eur J Heart Fail, January 1, 2007; 9(1): 92 - 97. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A J Camm, I Savelieva, G Y H Lip, and on behalf of the Guideline Development Group for t Rate control in the medical management of atrial fibrillation Heart, January 1, 2007; 93(1): 35 - 38. [Full Text] [PDF]
|
|
|
|
|
|
O. D. Pedersen, P. Sondergaard, T. Nielsen, S. J. Nielsen, E. S. Nielsen, N. Falstie-Jensen, I. Nielsen, L. Kober, H. Burchardt, M. Seibaek, et al. Atrial fibrillation, ischaemic heart disease, and the risk of death in patients with heart failure Eur. Heart J., December 1, 2006; 27(23): 2866 - 2870. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. J. van Veldhuisen, H. Aass, D. El Allaf, P. H.J.M. Dunselman, L. Gullestad, M. Halinen, J. Kjekshus, L. Ohlsson, H. Wedel, J. Wikstrand, et al. Presence and development of atrial fibrillation in chronic heart failure: Experiences from the MERIT-HF Study Eur J Heart Fail, August 1, 2006; 8(5): 539 - 546. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
U. C. Hoppe, J. M. Casares, H. Eiskjaer, A. Hagemann, J. G.F. Cleland, N. Freemantle, and E. Erdmann Effect of Cardiac Resynchronization on the Incidence of Atrial Fibrillation in Patients With Severe Heart Failure Circulation, July 4, 2006; 114(1): 18 - 25. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. G. Olsson, K. Swedberg, A. Ducharme, C. B. Granger, E. L. Michelson, J. J.V. McMurray, M. Puu, S. Yusuf, M. A. Pfeffer, and on behalf of the CHARM Investigators 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 J. Am. Coll. Cardiol., May 16, 2006; 47(10): 1997 - 2004. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. J. van Veldhuisen, H. J.G.M. Crijns, and M. P. van den Berg Heart failure, atrial fibrillation, and beta-blockers Eur. Heart J., January 2, 2006; 27(2): 247 - 247. [Full Text] [PDF]
|
|