Among patients hospitalized for acute heart failure, history of atrial fibrillation (AFib) or atrial flutter may be independently associated with a blunted course of in-hospital decongestion, according to research published Nov. 5 in JACC: Heart Failure, which will be presented at AHA 2018 in Chicago, IL.

Using covariate-adjusted linear and ordinal logistic regression models, Ravi B. Patel, MD, et al., sought to assess the association between history of AFib or atrial flutter and in-hospitals changes in various metrics of congestion. They pooled patients from three randomized trials of acute heart failure conducted within the Heart Failure Network: the DPSE trial, ROSE trial and CARRESS-HF trial.

Results showed that out of 750 unique patients, 418 (56 percent) had a history of AFib or atrial flutter. Left ventricular ejection fraction was found to be higher (35 percent vs. 27 percent), while N-terminal pro-brain natriuretic peptide (NT-proBNP) levels were not significantly lower at baseline in patients with AFib or atrial flutter.

After adjustment of covariates, the authors found that history of AFib or atrial flutter was associated with less substantial loss of weight and decrease in NT-proBNP levels, as well as a blunted increase in global sense of wellbeing, by 72 or 96 hours. There was no association between history of AFib or atrial flutter and change in orthodema congestion score or 60-day composite clinical endpoint.

"Further research is required to investigate the utility of rhythm-controlling therapies in promoting decongestion, relieving patient symptoms, and improving clinical outcomes in the setting of concomitant AFib or atrial flutter and acute heart failure," the authors conclude.

Clinical Topics: Anticoagulation Management, Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Anticoagulation Management and Atrial Fibrillation, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure, Heart Failure and Cardiac Biomarkers

Keywords: AHA18, AHA Annual Scientific Sessions, Natriuretic Peptide, Brain, Atrial Flutter, Atrial Fibrillation, Logistic Models, Stroke Volume, Peptide Fragments, Heart Failure, Ventricular Function, Left

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