Takeaway
- A significant proportion of patients with atrial fibrillation (AF) were prescribed loop diuretic agents, even without a formal diagnosis of heart failure (HF) and had an increased risk of HF hospitalisation and death.
Why this matters
- Findings suggest that targeted evaluation of patients with AF may allow earlier HF diagnosis, timely intervention with guideline-recommended HF therapy and better outcomes, particularly in women with AF who have a higher prevalence of unrecognised HF.
Study design
- A population-based cohort study of 124,256 people with incident AF from the UK Clinical Practice Research Datalink linked to secondary care records from Hospital Episodes Statistics and national death registration data.
- Repeat prescriptions for loop diuretics, without a diagnosis of HF or documented non-cardiac indication, were classified as isolated loop diuretic use.
- Funding: Imperial College London.
Key results
- Of 124,256 patients with incident AF, 22,001 (17.7%) had a prior or concomitant diagnosis of HF and 22,325 (18.0%) had isolated loop diuretic use.
- During a median follow-up of 2.9 years, 12,182 patients were diagnosed with HF (incidence rate, 3.2/100 person-years [95% CI, 3.1-3.3]).
- Of these, 3999 (32.8%) had prior isolated loop diuretic use, including 1228/3964 (31%) patients diagnosed with HF following an unplanned hospitalisation.
- The median time from AF to HF diagnosis was 3.6 (1.2-7.7) years in men vs 5.1 (1.8-9.9) years in women (P=.0001).
- Patients with isolated loop diuretic use vs those without HF or loop diuretic use had an increased risk of (adjusted HR; 95% CI):
- mortality (1.42; 1.37-1.47); and
- unplanned HF hospitalisation (1.60; 1.42-1.80; P<.0005 for both).
Limitations
- Risk of residual confounding.
This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.
