Prognostic relevance of atrial fibrillation in patients with chronic heart failure on long-term treatment with beta-blockers: results from COMET
Abstract
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.
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New-onset atrial fibrillation in heart failure patients might be associated with a particularly poor prognosis.
“Moreover, new-onset AF in heart failure patients might be associated with a particularly poor prognosis.31, 32”
From Worldwide Epidemiology of Atrial Fibrillation: A Global Burden of Disease 2010 Study (2014) · cites this paper as [31]
Cites
Effects of Enalapril on Mortality in Severe Congestive Heart Failure
The Consensus Trial Study Group* (1987) · New England Journal of Medicine · doi:10.1056/nejm198706043162301 · Cited by 5,109 · see citing works
Swedberg, K. B., & KJEKSHUS, J. K. (1988) · The American Journal of Cardiology · doi:10.1016/s0002-9149(88)80087-0 · Cited by 3,762 · see citing works
Self-citationThe effect of digoxin on mortality and morbidity in patients with heart failure
(1997) · New England Journal of Medicine · doi:10.1056/nejm199702203360801 · Cited by 3,016 · see citing works
Pitt, B., Poole-Wilson, P. A., Segal, R., Martínez, F. A., Dickstein, K., Camm, A. J., Konstam, M. A., Riegger, G. A. J., Klinger, G. H., Neaton, J. D., et al. (2000) · The Lancet · doi:10.1016/s0140-6736(00)02213-3 · Cited by 1,954 · see citing works
Self-citationPfeffer, M. A., Swedberg, K. B., Granger, C. B., Held, P., McMurray, J. J. V., Michelson, E. L., Olofsson, B., Östergren, J., & Yusuf, S. (2003) · The Lancet · doi:10.1016/s0140-6736(03)14282-1 · Cited by 1,885 · see citing works
Self-citationPoole-Wilson, P. A., Swedberg, K., Cleland, J. G., Di Lenarda, A., Hanrath, P., Komajda, M., Lubsen, J., Lutiger, B., Metra, M., Remme, W. J., et al. (2003) · The Lancet · doi:10.1016/s0140-6736(03)13800-7 · Cited by 1,872 · see citing works
Self-citationCleland, J. G. F. (2003) · European Heart Journal · doi:10.1016/s0195-668x(02)00823-0 · Cited by 1,551 · see citing works
Self-citationAmiodarone in Patients with Congestive Heart Failure and Asymptomatic Ventricular Arrhythmia
Singh, S. N., Fletcher, R. D., Fisher, S. G., Singh, B. N., Lewis, H. D., DEEDWANIA, P. C., Massie, B. M., Colling, C. L., & Lazzeri, D. (1995) · New England Journal of Medicine · doi:10.1056/nejm199507133330201 · Cited by 1,217 · see citing works
Dofetilide in Patients with Congestive Heart Failure and Left Ventricular Dysfunction
Torp-Pedersen, C. T., Møller, M., Bloch-Thomsen, P.-E., Køber, L., Sandøe, E., Egstrup, K., Agner, E., Carlsen, J. E., Videbæk, J., Marchant, B., et al. (1999) · New England Journal of Medicine · doi:10.1056/nejm199909163411201 · Cited by 1,012 · see citing works
Self-citationDries, D. L., Exner, D., Gersh, B., DOMANSKI, M. J., Waclawiw, M. A., & Stevenson, L. W. (1998) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(98)00297-6 · Cited by 963 · see citing works
Randomised trial of low-dose amiodarone in severe congestive heart failure
Doval, H., Nul, D. R., Grancelli, H., Perrone, S. V., Bortman, G., & Curiel, R. (1994) · The Lancet · doi:10.1016/s0140-6736(94)91895-3 · Cited by 913 · see citing works
Kannel, W. B., & Belanger, A. J. (1991) · American Heart Journal · doi:10.1016/0002-8703(91)90225-7 · Cited by 800 · see citing works
Prognostic significance of atrial fibrillation in advanced heart failure. A study of 390 patients.
Middlekauff, H. R., Stevenson, W., & Stevenson, L. W. (1991) · Circulation · doi:10.1161/01.cir.84.1.40 · Cited by 585 · see citing works
Lechat, P. P., Hulot, J., Escolano, S., Mallet, A., Leizorovicz, A., Werhlen-Grandjean, M., Pochmalicki, G., & Dargie, H. (2001) · Circulation · doi:10.1161/01.cir.103.10.1428 · Cited by 526 · see citing works
DEEDWANIA, P. C., Singh, B. N., Ellenbogen, K. A., Fisher, S. G., Fletcher, R. D., & Singh, S. N. (1998) · Circulation · doi:10.1161/01.cir.98.23.2574 · Cited by 505 · see citing works
Pedersen, O. D., Bagger, H., Keller, N., Marchant, B., Køber, L., & Torp-Pedersen, C. (2001) · Circulation · doi:10.1161/01.cir.104.3.292 · Cited by 496 · see citing works
Self-citationCarson, P. E., Johnson, G. R., Dunkman, W. B., Fletcher, R. D., Farrell, L., & Cohn, J. N. (1993) · PubMed · Cited by 319 · see citing works
Syncope in advanced heart failure: high risk of sudden death regardless of origin of syncope
Middlekauff, H. R., Stevenson, W. G., Stevenson, L. W., & Saxon, L. A. (1993) · Journal of the American College of Cardiology · doi:10.1016/0735-1097(93)90724-f · Cited by 311 · see citing works
Crijns, H. J. G. M. (2000) · European Heart Journal · doi:10.1053/euhj.1999.2107 · Cited by 259 · see citing works
Amiodarone Interaction With β-Blockers
Boutitie, F., Boissel, J., Connolly, S. J., Camm, A. J., Cairns, J. A., Julian, D. G., Gent, M., Janse, M. J., Dorian, P., & Frangin, G. (1999) · Circulation · doi:10.1161/01.cir.99.17.2268 · Cited by 249 · see citing works
Improving survival for patients with advanced heart failure: A study of 737 consecutive patients
Stevenson, W. G., Stevenson, L. W., Middlekauff, H. R., Fonarow, G. C., Hamilton, M. A., Woo, M. A., Saxon, L. A., Natterson, P. D., Steimle, A. E., Walden, J. A., et al. (1995) · Journal of the American College of Cardiology · doi:10.1016/0735-1097(95)00341-x · Cited by 220 · see citing works
Improving survival for patients with atrial fibrillation and advanced heart failure
Stevenson, W. G., Stevenson, L. W., Middlekauff, H. R., Fonarow, G. C., Hamilton, M. A., Woo, M. A., Saxon, L. A., Natterson, P. D., Steimle, A. E., Walden, J. A., et al. (1996) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(96)00358-0 · Cited by 218 · see citing works
Carson, P. E., Johnson, G. R., Dunkman, W. B., Fletcher, R. D., Farrell, L., & Cohn, J. N. (1993) · Circulation · Cited by 157 · see citing works
The AF-CHF Trial Investigators (2002) · American Heart Journal · doi:10.1016/s0002-8703(02)00129-1 · Cited by 148 · see citing works
Mathew, J., Hunsberger, S., Fleg, J. L., Sherry, F. M., Williford, W. O., & Yusuf, S. (2000) · CHEST Journal · doi:10.1378/chest.118.4.914 · Cited by 139 · see citing works
Mahoney, P. D., Kimmel, S., DeNofrio, D., Wahl, P. M., & Loh, E. (1999) · The American Journal of Cardiology · doi:10.1016/s0002-9149(99)00144-7 · Cited by 133 · see citing works
Joglar, J. A., Acusta, A., Shusterman, N. H., Ramaswamy, K., Kowal, R. C., Barbera, S. J., Hamdan, M. H., & Page, R. L. (2001) · American Heart Journal · doi:10.1067/mhj.2001.117318 · Cited by 126 · see citing works
Poole-Wilson, P. A., Cleland, J. G. F., Lenarda, A. D., Hanrath, P., Michel Komajda, N., Metra, M., Remme, W. J., Swedberg, K. B., & Torp-Pedersen, C. T. (2002) · European Journal of Heart Failure · doi:10.1016/s1388-9842(02)00025-9 · Cited by 89 · see citing works
Self-citationHognestad, A., Dickstein, K., Myhre, E. S. P., et al. (2004) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2003.11.027 · Cited by 80 · see citing works
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2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure
McDonagh, T. A., Metra, M., Adamo, M., Gardner, R. S., Baumbach, A., Böhm, M., Burri, H., Butler, J., Čelutkienė, J., Chioncel, O., et al. (2021) · European Heart Journal · doi:10.1093/eurheartj/ehab368 · Cited by 13,344 · see citing works
Self-citation2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure
Ponikowski, P., Voors, A. A., Anker, S. D., Bueno, H., Cleland, J. G. F., Coats, A. J. S., Falk, V., González-Juanatey, J. R., Harjola, V.-P., Jankowska, E. A., et al. (2016) · European Heart Journal · doi:10.1093/eurheartj/ehw128 · Cited by 11,429 · see citing works
Self-citation2016 ESC Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure
Ponikowski, P., Voors, A. A., Anker, S. D., Bueno, H., Cleland, J. G. F., Coats, A. J. S., Falk, V., González-Juanatey, J. R., Harjola, V.-P., Jankowska, E. A., et al. (2016) · European Journal of Heart Failure · doi:10.1002/ejhf.592 · Cited by 5,866 · see citing works
Self-citationWorldwide Epidemiology of Atrial Fibrillation: A Global Burden of Disease 2010 Study
Chugh, S. S., Havmoeller, R., Narayanan, K., Singh, D., Rienstra, M., Benjamin, E. J., Gillum, R. F., Kim, Y.-H., McAnulty, J. H., Zheng, Z.-J., et al. (2014) · Circulation · doi:10.1161/circulationaha.113.005119 · Cited by 4,506 · see citing works
Olsson, L. G., Swedberg, K., Ducharme, A., Granger, C. B., Michelson, E. L., McMurray, J. J. V., Puu, M., Yusuf, S., & Pfeffer, M. A. (2006) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2006.01.060 · Cited by 574 · see citing works
A Meta-Analysis of the Prognostic Significance of Atrial Fibrillation in Chronic Heart Failure
Mamas, M. A., Caldwell, J. C., Chacko, S., Garratt, C. J., Fath-Ordoubadi, F., & Neyses, L. (2009) · European Journal of Heart Failure · doi:10.1093/eurjhf/hfp085 · Cited by 393 · see citing works
Du, X., Ninomiya, T., de Galan, B., Abadir, E., Chalmers, J., Pillai, A., Woodward, M., Cooper, M., Harrap, S., Hamet, P., et al. (2009) · European Heart Journal · doi:10.1093/eurheartj/ehp055 · Cited by 239 · see citing works
The European CRT Survey: 1 year (9–15 months) follow-up results
Bogale, N., Priori, S., Cleland, J. G. F., Brugada, J., Linde, C., Auricchio, A., van Veldhuisen, D. J., Limbourg, T., Gitt, A., Gras, D., et al. (2012) · European Journal of Heart Failure · doi:10.1093/eurjhf/hfr158 · Cited by 98 · see citing works
Self-citationKupper, N., Gidron, Y., Winter, J., & Denollet, J. (2009) · Psychosomatic Medicine · doi:10.1097/psy.0b013e3181bee6dc · Cited by 85 · see citing works
- Authors
- Swedberg, K., Olsson, L. G., Charlesworth, A., Cleland, J., Hanrath, P., Komajda, M., Metra, M., Torp-Pedersen, C., & Poole-Wilson, P.
- Affiliations
- Sahlgrenska University Hospital (SE)
- Venue
- European Heart Journal
- Publisher
- Oxford University Press (OUP)
- Published
- 2005-03-14
- Volume
- 26
- Issue
- 13
- Pages
- 1303-1308
- ISSN
- 0195-668X (ISSN-L)
- 1522-9645
- OpenAlex
- W1966023162
- Cited by
- 647
- References
- 30
- Citations by year
- 2026: 4 · 2025: 8 · 2024: 11 · 2023: 8 · 2022: 9 · 2021: 21 · 2020: 13 · 2019: 18 · 2018: 9 · 2017: 28 · 2016: 26 · 2015: 23 · 2014: 20 · 2013: 28 · 2012: 29
- FWCI
- 58.78
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Heart Journal (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- RWTH Publications (RWTH Aachen) (submittedVersion)
- 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, beta-blockers, carvedilol, metoprolol tartrate, mortality, heart failure hospitalization, prognostic factors, new-onset atrial fibrillation, COMET trial, NYHA functional class, cardiovascular mortality
- MeSH terms
- Carvedilol, Adrenergic beta-Antagonists, Aged, Atrial Fibrillation, Carbazoles, Double-Blind Method, Electrocardiography, Female, Heart Failure, Humans, Long-Term Care, Male, Metoprolol, Middle Aged, Prognosis, Propanolamines, Ventricular Dysfunction, Left
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