BEST: AF linked with increased HF hospitalization, not linked with all-cause mortality

Researchers examined data from a cohort of 974 patients from the BEST study, which examined bucindolol (Gencaro, Arca Biopharama Inc.) in advanced systolic HF. The overall BEST results were previously reported. The researchers propensity-matched the patients and assigned them to either a group with a history of AF (n=487) or no history of AF (n=487). The primary study outcomes were all-cause mortality and HF hospitalization, and patients were followed for a mean of 23 months.

According to the study results, a total of 368 propensity-matched patients died during follow-up, including 314 (32%) attributed to CV causes and 110 (11%) due to HF. All-cause mortality occurred in 187 patients (2,046 per 10,000 person years) with a history of AF and 181 (1,885 per 10,000 person years) patients without a history of AF (HR=1.03; 95% CI, 0.79-1.33). The researchers also reported that 630 (65%) patients were hospitalized during follow-up, with 399 (41%) hospitalizations attributed to HF. Of those, 215 patients with AF (3,171 per 10,000 person years) were hospitalized with HF vs. 184 patients without AF (2,405 per 10,000 person years) who were hospitalized with HF (HR=1.28; 95% CI, 1.00-1.63). Cardiovascular mortality was reported in 156 patients with AF (1,706 per 10,000 person years) and 158 patients without AF (1,645 per 10,000 person years).

“AF seems to have an intrinsic association with hospitalization due to worsening HF, which was worse in patients not receiving bucindolol,” concluded the researchers. “Despite the overall lack of an intrinsic association of AF with mortality, it appears to increase mortality in those not receiving bucindolol. These data provide additional arguments that HF patients with AF should be treated with beta-blockers in the absence of an absolute contraindication.” Bucindolol is not approved in the United States

For more information:

Ahmed M. Eur Heart J. 2009;doi:10.1093/eurheartj/ehp222.