Disease-modifying HF medications can help reduce mortality risk in patients with ADHF

Hyperuricaemia, ejection fraction of <40 percent, and elevated NTproBNP* and urea levels appear to be associated with a significantly increased risk of mortality in patients with atrial fibrillation (AF) who were admitted for ADHF**, while the use of disease-modifying heart failure (HF) medications at admission and discharge may reduce the risk, according to a study presented at ESC Asia 2019.

“HF and AF commonly coexist, each, predisposing the other. AF may inflict haemodynamic disturbances, leading to reduced cardiac output, and hence acute decompensation. Ultimately, mortality risk is further increased. Identifying contributing factors is thus vital lest increasing risk of poor outcome,” according to the researchers.

The researchers retrospectively analysed 810 patients with AF (64.7 percent male) who were first admitted for ADHF between 2009 and 2018. [ESC Asia 2019, abstract P252]

Overall mortality rates were 5.1 percent upon admission, and 14.4 and 40.5 percent at 1 and 3 years of follow-up after hospital admission.

In a multivariate analysis, hyponatraemia of Na<135 mmol/L (adjusted odds ratio [adjOR], 2.49, 95 percent confidence interval [CI], 1.91–5.20; p=0.015), uric acid level of ≥675 µmol/L(adjOR, 2.75, 95 percent CI, 1.31–5.79; p=0.008), and ejection fraction of <40 percent (adjOR, 3.93, 95 percent CI, 1.63–9.49; p=0.002) were associated with a significant increased risk of in-hospital mortality.

At 1 year, those with NTproBNP level of ≥7,500 pg/mL (adjusted hazard ratio [adjHR], 1.64, 95 percent CI, 1.02–2.65; p=0.042) and urea level of >7 mmol/L (adjHR, 1.86, 95 percent CI, 1.04–3.32; p=0.036) had a significantly increased risk ofmortality. “[Notably,] elevated NTproBNP and urea levels seemed to have more effect on mortality at 1 year compared to 3 years,” said the researchers.

Patients who had backgroundcoronary artery disease (adjHR, 1.72, 95 percent CI, 1.09–2.71; p=0.02), hypernatraemia of Na>145 mmol/L (adjHR, 14.89, 95 percent CI, 3.17–69.86; p=0.001), and ejection fraction of <40 percent (adjHR, 2.00; 95 percent CI, 1.28–3.12; p=0.002) also demonstrated a significantly increased risk of mortality at 3 years.

However, patients who received disease-modifying HF medications, particularly ACEi/ARB + BB + MRA***, at hospital admission (adjOR, 0.07, 95 percent CI, 0.02–0.30; p<0.001) and discharge (adjHR, 0.23, 95 percent CI, 0.09–0.60; p=0.003 for 1 year and adjHR, 0.193, 95 percent CI, 0.09–0.43; p<0.001 for 3 years) had significantly reduced mortality risk.

“[Our results highlighted that] patients with AF who presented with ADHF had a variety of mortality predictors that influence at different timelines,” said the researchers.

*NTproBNP: N-terminal pro b-type natriuretic peptide

**ADHF: Acute decompensated heart failure

***ACEi/ARB + BB + MRA: Angiotensin Converting Ezyme inhibitor/Angiotensin Receptor Blocker + Beta Blocker + Mineralocorticoid Receptor Antagonist