{"title":"不同射血分数段心房颤动与心力衰竭患者报告结果之间的关系。","authors":"Khaled Elkholey , Zain Ul Abideen Asad , Esraa Shehata , Irina Mustafina , Marat Fudim , Stavros Stavrakis","doi":"10.1016/j.ahj.2024.04.017","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>Atrial fibrillation (AF) is common in patients with heart failure (HF) and is associated with worse clinical outcomes. We evaluated the relationship between AF and longitudinal changes in health-related quality of life (HRQoL) measured by Kansas City Cardiomyopathy Questionnaire (KCCQ) in both HF with preserved (HFpEF) and reduced ejection fraction (HFrEF).</p></div><div><h3>Methods</h3><p>This is a post-hoc analysis of the TOPCAT and HF-ACTION trials. The effect of AF on KCCQ overall summary scores (OSS), in both trials, was examined using a mixed effects regression model. Patients were divided into 3 groups according to AF status at baseline: patients with a history of AF but no AF detected on ECG at enrollment (Hx AF group), patients with history of AF and AF detected on ECG at enrollment (ECG AF group) and patients with post-randomization new-onset AF (New AF group).</p></div><div><h3>Results</h3><p>In TOPCAT, among 1,710 patients with KCCQ data available, AF was associated with a significantly lower KCCQ-OSS (-3.98; 95% CI −7.21: −0.74) at 48 months, with a significant AF status by time interaction (<em>P</em> = .03). In HF-ACTION, among 1,814 patients with available KCCQ data, AF was associated with a significantly lower KCCQ-OSS (-3.67; 95% CI −6.21: −1.41) at 24 months but there was no significant AF status by time interaction. In both trials, the type of AF was not associated with significant changes in KCCQ-OSS score.</p></div><div><h3>Conclusion</h3><p>Ιn patients with both HFpEF and HFrEF, AF was independently associated with worse HRQoL measured by KCCQ.</p></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":null,"pages":null},"PeriodicalIF":3.7000,"publicationDate":"2024-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Association between atrial fibrillation and heart failure patient reported outcomes across the ejection fraction spectrum\",\"authors\":\"Khaled Elkholey , Zain Ul Abideen Asad , Esraa Shehata , Irina Mustafina , Marat Fudim , Stavros Stavrakis\",\"doi\":\"10.1016/j.ahj.2024.04.017\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>Atrial fibrillation (AF) is common in patients with heart failure (HF) and is associated with worse clinical outcomes. We evaluated the relationship between AF and longitudinal changes in health-related quality of life (HRQoL) measured by Kansas City Cardiomyopathy Questionnaire (KCCQ) in both HF with preserved (HFpEF) and reduced ejection fraction (HFrEF).</p></div><div><h3>Methods</h3><p>This is a post-hoc analysis of the TOPCAT and HF-ACTION trials. The effect of AF on KCCQ overall summary scores (OSS), in both trials, was examined using a mixed effects regression model. Patients were divided into 3 groups according to AF status at baseline: patients with a history of AF but no AF detected on ECG at enrollment (Hx AF group), patients with history of AF and AF detected on ECG at enrollment (ECG AF group) and patients with post-randomization new-onset AF (New AF group).</p></div><div><h3>Results</h3><p>In TOPCAT, among 1,710 patients with KCCQ data available, AF was associated with a significantly lower KCCQ-OSS (-3.98; 95% CI −7.21: −0.74) at 48 months, with a significant AF status by time interaction (<em>P</em> = .03). In HF-ACTION, among 1,814 patients with available KCCQ data, AF was associated with a significantly lower KCCQ-OSS (-3.67; 95% CI −6.21: −1.41) at 24 months but there was no significant AF status by time interaction. In both trials, the type of AF was not associated with significant changes in KCCQ-OSS score.</p></div><div><h3>Conclusion</h3><p>Ιn patients with both HFpEF and HFrEF, AF was independently associated with worse HRQoL measured by KCCQ.</p></div>\",\"PeriodicalId\":7868,\"journal\":{\"name\":\"American heart journal\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":3.7000,\"publicationDate\":\"2024-04-27\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"American heart journal\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0002870324001042\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"American heart journal","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0002870324001042","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
摘要
背景:心房颤动(AF)在心力衰竭(HF)患者中很常见,并且与较差的临床预后有关。我们评估了在射血分数保留型心力衰竭(HFpEF)和射血分数降低型心力衰竭(HFrEF)患者中,房颤与堪萨斯城心肌病问卷(KCCQ)测量的健康相关生活质量(HRQoL)纵向变化之间的关系:这是对 TOPCAT 和 HF-ACTION 试验的事后分析。在这两项试验中,房颤对 KCCQ 总体总分(OSS)的影响均采用混合效应回归模型进行检验。根据基线时的房颤状态将患者分为三组:有房颤病史但入选时心电图未检测到房颤的患者(Hx AF 组)、有房颤病史且入选时心电图检测到房颤的患者(ECG AF 组)和随机化后新发房颤的患者(New AF 组):在 TOPCAT 中,1710 名有 KCCQ 数据的患者中,房颤与 48 个月时 KCCQ-OSS 的显著降低相关(-3.98;95% CI -7.21:-0.74),房颤状态与时间的交互作用显著(P=0.03)。在 HF-ACTION 试验中,在 1814 名有 KCCQ 数据的患者中,房颤与 24 个月时 KCCQ-OSS 的显著降低相关(-3.67;95% CI -6.21:-1.41),但房颤状态与时间之间没有显著的交互作用。在这两项试验中,房颤类型与 KCCQ-OSS 评分的显著变化无关:结论:在 HFpEF 和 HFrEF 患者中,心房颤动与 KCCQ 测量的 HRQoL 差异无关。
Association between atrial fibrillation and heart failure patient reported outcomes across the ejection fraction spectrum
Background
Atrial fibrillation (AF) is common in patients with heart failure (HF) and is associated with worse clinical outcomes. We evaluated the relationship between AF and longitudinal changes in health-related quality of life (HRQoL) measured by Kansas City Cardiomyopathy Questionnaire (KCCQ) in both HF with preserved (HFpEF) and reduced ejection fraction (HFrEF).
Methods
This is a post-hoc analysis of the TOPCAT and HF-ACTION trials. The effect of AF on KCCQ overall summary scores (OSS), in both trials, was examined using a mixed effects regression model. Patients were divided into 3 groups according to AF status at baseline: patients with a history of AF but no AF detected on ECG at enrollment (Hx AF group), patients with history of AF and AF detected on ECG at enrollment (ECG AF group) and patients with post-randomization new-onset AF (New AF group).
Results
In TOPCAT, among 1,710 patients with KCCQ data available, AF was associated with a significantly lower KCCQ-OSS (-3.98; 95% CI −7.21: −0.74) at 48 months, with a significant AF status by time interaction (P = .03). In HF-ACTION, among 1,814 patients with available KCCQ data, AF was associated with a significantly lower KCCQ-OSS (-3.67; 95% CI −6.21: −1.41) at 24 months but there was no significant AF status by time interaction. In both trials, the type of AF was not associated with significant changes in KCCQ-OSS score.
Conclusion
Ιn patients with both HFpEF and HFrEF, AF was independently associated with worse HRQoL measured by KCCQ.
期刊介绍:
The American Heart Journal will consider for publication suitable articles on topics pertaining to the broad discipline of cardiovascular disease. Our goal is to provide the reader primary investigation, scholarly review, and opinion concerning the practice of cardiovascular medicine. We especially encourage submission of 3 types of reports that are not frequently seen in cardiovascular journals: negative clinical studies, reports on study designs, and studies involving the organization of medical care. The Journal does not accept individual case reports or original articles involving bench laboratory or animal research.