Cited by 574Atrial Fibrillation Management and OutcomesHeart Failure Treatment and ManagementCardiac Health and Mental Health

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Atrial Fibrillation and Risk of Clinical Events in Chronic Heart Failure With and Without Left Ventricular Systolic Dysfunction

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Olsson, Lars G., Swedberg, Karl, Ducharme, Anique, Granger, Christopher B., Michelson, Eric L., McMurray, John J.V., Puu, Margareta, Yusuf, Salim, Pfeffer, Marc A.·2006·Journal of the American College of Cardiology

DOI 10.1016/j.jacc.2006.01.060

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Abstract

Objectives We assessed the risk of adverse cardiovascular (CV) outcomes associated with atrial fibrillation (AF) in the Candesartan in Heart failure-Assessment of Reduction in Mortality and morbidity (CHARM) program, which enrolled patients with chronic heart failure (CHF) and a broad range of ejection fractions (EFs).Background Atrial fibrillation is associated with an increased risk of adverse CV outcomes in patients with CHF and reduced EF. The risk of AF in patients with CHF and preserved left ventricular ejection fraction (PEF) is unknown.Methods A total of 7,599 patients with symptomatic CHF were randomized to candesartan or placebo. Patients were divided by baseline EF (< or =40% or >40%) in low or preserved EF groups. Major outcomes were cardiovascular death or hospitalization for worsening heart failure, and all-cause mortality. Median follow-up was 37.7 months.Results A total of 670 (17%) patients in the low EF group and 478 (19%) in the PEF group had AF at baseline. Atrial fibrillation predicted a high risk of cardiovascular morbidity and mortality regardless of baseline EF. Patients with AF and low EF had the highest absolute risk for adverse CV outcomes. However, AF was associated with greater relative increased risk of the major outcomes in patients with PEF than in patients with low EF: hazard ratio 1.72 (95% confidence interval [CI] 1.45 to 2.06) versus 1.29 (95% CI 1.14 to 1.46), respectively. The same was true for the risk of all-cause mortality. Candesartan was associated with similar treatment effects regardless of baseline rhythm.Conclusions Atrial fibrillation is associated with an increased risk of CV outcomes in patients with CHF and either reduced EF or PEF. Candesartan improved outcomes similarly regardless of baseline rhythm.

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Authors: Olsson, L. G., Swedberg, K., Ducharme, A., Granger, C. B., Michelson, E. L., McMurray, J. J. V., Puu, M., Yusuf, S., & Pfeffer, M. A.
Affiliations: Sahlgrenska University Hospital (SE)
Montreal Heart Institute (CA)
Duke Medical Center (US)
AstraZeneca (United States) (US)
Western Infirmary (GB)
AstraZeneca (Sweden) (SE)
Brigham and Women's Hospital (US)
Corresponding author: Swedberg, Karl
ORCID: Swedberg, Karl
Ducharme, Anique
Granger, Christopher B.
McMurray, John J.V.
Yusuf, Salim
Pfeffer, Marc A.
Venue: Journal of the American College of Cardiology
Publisher: Elsevier BV
Published: 2006-05
Volume: 47
Issue: 10
Pages: 1997-2004
ISSN: 0735-1097 (ISSN-L)
DOI: 10.1016/j.jacc.2006.01.060
OpenAlex: W104425974
Cited by: 574
References: 35
Citations by year: 2026: 17 · 2025: 25 · 2024: 26 · 2023: 17 · 2022: 18 · 2021: 37 · 2020: 33 · 2019: 24 · 2018: 22 · 2017: 39 · 2016: 37 · 2015: 32 · 2014: 25 · 2013: 44 · 2012: 29
FWCI: 23.22
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/open-access/userlicense/1.0/ (vor, 2670 d)
Locations: Journal of the American College of Cardiology (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
Keywords: atrial fibrillation, chronic heart failure, left ventricular systolic dysfunction, preserved ejection fraction, candesartan, cardiovascular mortality, hospitalization for worsening heart failure, all-cause mortality, CHARM trial, angiotensin receptor blockers
MeSH terms: Aged, Atrial Fibrillation, Benzimidazoles, Biphenyl Compounds, Cardiovascular Diseases, Chronic Disease, Female, Heart Failure, Hospitalization, Humans, Male, Middle Aged, Prognosis, Risk, Stroke Volume, Tetrazoles, Ventricular Dysfunction, Left, Angiotensin II Type 1 Receptor Blockers

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Atrial Fibrillation and Risk of Clinical Events in Chronic Heart Failure With and Without Left Ventricular Systolic Dysfunction

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