Atrial fibrillation and mortality in African American patients with heart failure

Results from the African American Heart Failure Trial (A-HeFT)

Judith E. Mitchell, S. William Tam, Kamini Trivedi, Anne L. Taylor, Welton O'Neal, Jay N. Cohn, Manuel Worcel

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background: Atrial fibrillation (AF) is common in patients with heart failure (HF) and portends a worsened prognosis. Because of the low enrollment of African American subjects (AAs) in randomized HF trials, there are little data on AF in AAs with HF. This post hoc analysis reviews characteristics and outcomes of AA patients with AF in A-HeFT. Methods and Results: A total of 1,050 AA patients with New York Heart Association class III/IV systolic HF, well treated with neurohormonal blockade (87% β-blockers, 93% angiotensin-converting enzyme inhibitor and/or angiotensin receptor blocker), were randomized to an added fixed-dose combination of isosorbide dinitrate/hydralazine (FDC I/H) or placebo. Atrial fibrillation was confirmed in 174 (16.6%) patients at baseline and in an additional 9 patients who developed AF during the study, for a final cohort of 183 (17.4%). Comparison of patients with AF versus no AF revealed the following: mean age 61 ± 12 versus 56 ± 13 years (P <.001), systolic blood pressure (BP) 124 ± 18 versus 127 ± 18 mm Hg (P =.044), diastolic BP 74 ± 11 versus 77 ± 10 mm Hg (P =.002), creatinine level 1.4 ± 0.5 versus 1.2 ± 0.5 mg/dL (P <.001), and brain natriuretic peptide 431 ± 443 versus 283 ± 396 pg/mL (P <.001). No significant difference was observed in ejection fraction, left ventricular end-diastolic diameter, or quality-of-life scores. However, AF increased the risk of mortality significantly among AA patients (P =.018), and the use of FDC I/H reduced the risk of mortality in patients with AF (HR 0.21, P =.002). Conclusion: African Americans with HF and AF (vs no AF) were older, had lower BP, and had higher creatinine and brain natriuretic peptide levels. Mortality and morbidity were worse when AF was present, and these data suggest that there may be an enhanced survival benefit with the use of FDC I/H in AA patients with HF and AF.

Original languageEnglish (US)
Pages (from-to)154-159
Number of pages6
JournalAmerican Heart Journal
Volume162
Issue number1
DOIs
StatePublished - Jan 1 2011

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African Americans
Atrial Fibrillation
Heart Failure
Mortality
Blood Pressure
Brain Natriuretic Peptide
Creatinine
Systolic Heart Failure
Angiotensin Receptor Antagonists
Angiotensin-Converting Enzyme Inhibitors
Stroke Volume
Placebos
Quality of Life
Hypertension
Morbidity

Cite this

Atrial fibrillation and mortality in African American patients with heart failure : Results from the African American Heart Failure Trial (A-HeFT). / Mitchell, Judith E.; Tam, S. William; Trivedi, Kamini; Taylor, Anne L.; O'Neal, Welton; Cohn, Jay N.; Worcel, Manuel.

In: American Heart Journal, Vol. 162, No. 1, 01.01.2011, p. 154-159.

Research output: Contribution to journalArticle

Mitchell, Judith E. ; Tam, S. William ; Trivedi, Kamini ; Taylor, Anne L. ; O'Neal, Welton ; Cohn, Jay N. ; Worcel, Manuel. / Atrial fibrillation and mortality in African American patients with heart failure : Results from the African American Heart Failure Trial (A-HeFT). In: American Heart Journal. 2011 ; Vol. 162, No. 1. pp. 154-159.
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abstract = "Background: Atrial fibrillation (AF) is common in patients with heart failure (HF) and portends a worsened prognosis. Because of the low enrollment of African American subjects (AAs) in randomized HF trials, there are little data on AF in AAs with HF. This post hoc analysis reviews characteristics and outcomes of AA patients with AF in A-HeFT. Methods and Results: A total of 1,050 AA patients with New York Heart Association class III/IV systolic HF, well treated with neurohormonal blockade (87{\%} β-blockers, 93{\%} angiotensin-converting enzyme inhibitor and/or angiotensin receptor blocker), were randomized to an added fixed-dose combination of isosorbide dinitrate/hydralazine (FDC I/H) or placebo. Atrial fibrillation was confirmed in 174 (16.6{\%}) patients at baseline and in an additional 9 patients who developed AF during the study, for a final cohort of 183 (17.4{\%}). Comparison of patients with AF versus no AF revealed the following: mean age 61 ± 12 versus 56 ± 13 years (P <.001), systolic blood pressure (BP) 124 ± 18 versus 127 ± 18 mm Hg (P =.044), diastolic BP 74 ± 11 versus 77 ± 10 mm Hg (P =.002), creatinine level 1.4 ± 0.5 versus 1.2 ± 0.5 mg/dL (P <.001), and brain natriuretic peptide 431 ± 443 versus 283 ± 396 pg/mL (P <.001). No significant difference was observed in ejection fraction, left ventricular end-diastolic diameter, or quality-of-life scores. However, AF increased the risk of mortality significantly among AA patients (P =.018), and the use of FDC I/H reduced the risk of mortality in patients with AF (HR 0.21, P =.002). Conclusion: African Americans with HF and AF (vs no AF) were older, had lower BP, and had higher creatinine and brain natriuretic peptide levels. Mortality and morbidity were worse when AF was present, and these data suggest that there may be an enhanced survival benefit with the use of FDC I/H in AA patients with HF and AF.",
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T1 - Atrial fibrillation and mortality in African American patients with heart failure

T2 - Results from the African American Heart Failure Trial (A-HeFT)

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AU - Tam, S. William

AU - Trivedi, Kamini

AU - Taylor, Anne L.

AU - O'Neal, Welton

AU - Cohn, Jay N.

AU - Worcel, Manuel

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N2 - Background: Atrial fibrillation (AF) is common in patients with heart failure (HF) and portends a worsened prognosis. Because of the low enrollment of African American subjects (AAs) in randomized HF trials, there are little data on AF in AAs with HF. This post hoc analysis reviews characteristics and outcomes of AA patients with AF in A-HeFT. Methods and Results: A total of 1,050 AA patients with New York Heart Association class III/IV systolic HF, well treated with neurohormonal blockade (87% β-blockers, 93% angiotensin-converting enzyme inhibitor and/or angiotensin receptor blocker), were randomized to an added fixed-dose combination of isosorbide dinitrate/hydralazine (FDC I/H) or placebo. Atrial fibrillation was confirmed in 174 (16.6%) patients at baseline and in an additional 9 patients who developed AF during the study, for a final cohort of 183 (17.4%). Comparison of patients with AF versus no AF revealed the following: mean age 61 ± 12 versus 56 ± 13 years (P <.001), systolic blood pressure (BP) 124 ± 18 versus 127 ± 18 mm Hg (P =.044), diastolic BP 74 ± 11 versus 77 ± 10 mm Hg (P =.002), creatinine level 1.4 ± 0.5 versus 1.2 ± 0.5 mg/dL (P <.001), and brain natriuretic peptide 431 ± 443 versus 283 ± 396 pg/mL (P <.001). No significant difference was observed in ejection fraction, left ventricular end-diastolic diameter, or quality-of-life scores. However, AF increased the risk of mortality significantly among AA patients (P =.018), and the use of FDC I/H reduced the risk of mortality in patients with AF (HR 0.21, P =.002). Conclusion: African Americans with HF and AF (vs no AF) were older, had lower BP, and had higher creatinine and brain natriuretic peptide levels. Mortality and morbidity were worse when AF was present, and these data suggest that there may be an enhanced survival benefit with the use of FDC I/H in AA patients with HF and AF.

AB - Background: Atrial fibrillation (AF) is common in patients with heart failure (HF) and portends a worsened prognosis. Because of the low enrollment of African American subjects (AAs) in randomized HF trials, there are little data on AF in AAs with HF. This post hoc analysis reviews characteristics and outcomes of AA patients with AF in A-HeFT. Methods and Results: A total of 1,050 AA patients with New York Heart Association class III/IV systolic HF, well treated with neurohormonal blockade (87% β-blockers, 93% angiotensin-converting enzyme inhibitor and/or angiotensin receptor blocker), were randomized to an added fixed-dose combination of isosorbide dinitrate/hydralazine (FDC I/H) or placebo. Atrial fibrillation was confirmed in 174 (16.6%) patients at baseline and in an additional 9 patients who developed AF during the study, for a final cohort of 183 (17.4%). Comparison of patients with AF versus no AF revealed the following: mean age 61 ± 12 versus 56 ± 13 years (P <.001), systolic blood pressure (BP) 124 ± 18 versus 127 ± 18 mm Hg (P =.044), diastolic BP 74 ± 11 versus 77 ± 10 mm Hg (P =.002), creatinine level 1.4 ± 0.5 versus 1.2 ± 0.5 mg/dL (P <.001), and brain natriuretic peptide 431 ± 443 versus 283 ± 396 pg/mL (P <.001). No significant difference was observed in ejection fraction, left ventricular end-diastolic diameter, or quality-of-life scores. However, AF increased the risk of mortality significantly among AA patients (P =.018), and the use of FDC I/H reduced the risk of mortality in patients with AF (HR 0.21, P =.002). Conclusion: African Americans with HF and AF (vs no AF) were older, had lower BP, and had higher creatinine and brain natriuretic peptide levels. Mortality and morbidity were worse when AF was present, and these data suggest that there may be an enhanced survival benefit with the use of FDC I/H in AA patients with HF and AF.

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