Factors associated with disease progression in patients with atrial fibrillation and heart failure anticoagulated with rivaroxaban
Nicolás Manito, José María Cepeda‐Rodrigo, Nuria Farré, Miguel Castillo Orive, Enrique Galve, Javier Jiménez‐Candil, José M. García‐Pinilla, Eduardo Sebastián López Sánchez, Carles Rafols, Juan José Gómez Doblas- Cardiology and Cardiovascular Medicine
- General Medicine
Abstract
Background
Patients with atrial fibrillation (AF) and heart failure (HF) have a high risk of thromboembolism and other outcomes and anticoagulation is recommended.
Hypothesis
This study was aimed to explore the risk factors associated with HF worsening in patients with AF and HF taking rivaroxaban in Spain.
Methods
Multicenter, prospective, observational study that included adults with AF and chronic HF, receiving rivaroxaban ≥4 months before entering. HF worsening was defined as first hospitalization or emergency visit because of HF exacerbation.
Results
A total of 672 patients from 71 Spanish centers were recruited, of whom 658 (97.9%) were included in the safety analysis and 552 (82.1%) in the per protocol analysis. At baseline, mean age was 73.7 ± 10.9 years, 64.9% were male, CHA2DS2‐VASc was 4.1 ± 1.5, HAS‐BLED was 1.6 ± 0.9% and 51.3% had HF with preserved ejection fraction. After 24 months of follow‐up, 24.9% of patients developed HF worsening, 11.6% died, 2.9% had a thromboembolic event, 3.1% a major bleeding, 0.5% an intracranial bleeding and no patient had a fatal hemorrhage. Older age, the history of chronic obstructive pulmonary disease, the previous use of vitamin K antagonists, and restrictive or infiltrative cardiomyopathies, were independently associated with HF worsening. Only 6.9% of patients permanently discontinued rivaroxaban treatment.
Conclusions
Approximately one out of four patients with HF and AF treated with rivaroxaban developed a HF worsening episode after 2 years of follow‐up. The identification of those factors that increase the risk of HF worsening could be helpful in the comprehensive management of this population.