Publications

Abstract Background and aim Heart failure (HF) is closely associated with atrial fibrillation (AF). The Atrial fibrillation Better Care (ABC) pathway is recommended in guidelines as a holistic or integrated care approach to AF management. However, few data are specifically available on ABC pathway adherence in AF patients with HF, especially according to HF phenotypes. Therefore, we aimed to retrospectively investigate the effect of ABC management in a large contemporary cohort of AF patients with HF and the impact on the clinical outcomes. Methods We analyzed patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry. According to the availability of HF status and ejection fraction (EF) values, patients were categorized as follows: i) non-HF; ii) HF EF>40% iii) HF EF≤40%. The primary outcome was a composite outcome of all-cause death and major adverse cardiac events. Results Among the original 11 096 AF patients enrolled, 9175 (82.7%) were included in this analysis (median age 71 years, interquartile range [IQR 63-77], 40.1% were female, with median EF 55% [IQR 45-61%] and median CHA2DS2-VASc 3 [2-4]). In this cohort, 5935 (64.7%) were non-HF patients, and 3240 (35.3%) had HF patients. According to the EF values, 2005 (65%) were categorized as HF EF>40%, and 1235 (35%) were HF EF≤40%. Overall, ABC pathway adherence in HF patients was 23.3% [95% CI: 21.6-25.2], being higher in HF EF≤40% patients (28.0%) and lower in HF EF>40% ones (21.9%). After a median follow-up of 731[IQR 690-748] days, ABC adherence was associated with a lower risk for the composite outcome compared to non-ABC adherent patients in each HF group (HF EF>40%: ABC 15.4% vs no ABC 20.9%; HF EF≤40%: ABC 20.3% vs no ABC 33.9%; both p<0.001). Cox regression analysis showed that ABC adherence was associated with a lower risk of composite outcome in each HF category (HF EF>40%: HR 0.66 [95% CI: 0.46-0.96], p=0.030; HF EF≤40%: HR 0.60 [95% CI: 0.40-0.90], p=0.013). ABC adherence was associated with a consistent risk reduction for the composite outcome across the entire EF spectrum [Figure]. Conclusions In this large contemporary cohort of AF-HF patients, adherence to the ABC pathway was associated with a lower occurrence of the primary outcome, irrespective of baseline EF. ABC pathway is consistently associated with a lower risk for adverse outcomes across the entire spectrum of EF.

Thromboembolic and bleeding events were not different between patients undergoing TEE-guided strategy and in those undergoing an optimized conventional anticoagulation approach for ECV of AF.

Abstract Background Atrial fibrillation (AF) is closely associated with mental health issues, with patients experiencing increased risks of both developing AF and mental distress, including anxiety and depression. Early rhythm control therapy may improve psychological outcomes in AF patients, especially those under 65 years with preexisting depression or anxiety. This study investigated whether initiating rhythm control within one year of AF diagnosis reduces healthcare utilization related to mental health in this population. Methods This study utilized data from the Korean National Health Insurance Service database, encompassing 166,797 patients under 65 years of age newly diagnosed with AF from 2010 to 2020 and with a history of depression or anxiety. Patients were divided into two groups: the Early Rhythm Control (ERC) group (receiving rhythm control within one year of diagnosis) and the usual care group. Primary outcomes included hospitalizations for depression or anxiety as the main diagnosis. Secondary outcomes encompassed hospitalizations with depression or anxiety among the top five diagnoses and psychiatric hospitalizations. Cox regression analyses and propensity score matching were used to assess outcome risks. Results During a median follow-up of 5.3 years, ERC was associated with a 28% reduced risk of primary outcome hospitalization compared to usual care (HR 0.715, 95% CI 0.63-0.81, p<0.001). Secondary outcomes also showed reduced risks: 20% for hospitalizations with depression or anxiety among the top diagnoses and 43% for any psychiatric hospitalization. After 1:1 propensity score matching, ERC continued to show a reduced risk of the primary outcome (HR 0.795, 95% CI 0.689-0.916, p=0.001), and secondary outcomes had similar findings (Figure). Subgroup analyses indicated consistent results across gender and age groups, with stronger effects observed in younger patients. Conclusion Early rhythm control therapy in patients under 65 with AF and preexisting mental health conditions is associated with significantly reduced risks of depression or anxiety-related hospitalizations and psychiatric hospitalizations. These findings suggest that early rhythm control may mitigate mental health-related healthcare utilization, underscoring the importance of timely rhythm management in this population.

Von Willebrand factor (vWF) is a biomarker of endothelial dysfunction. We investigated its role on prognosis in anticoagulated atrial fibrillation (AF) patients and determined whether its addition to clinical risk stratification schemes improved event-risk prediction. Consecutive outpatients with non-valvular AF were recruited and rates of thrombotic/cardiovascular events, major bleeding and mortality were recorded. The effect of vWF on prognosis was calculated using a Cox regression model. Improvements in predictive accuracy over current scores were determined by calculating the integrated discrimination improvement (IDI), net reclassification improvement (NRI), comparison of receiver-operator characteristic (ROC) curves and Decision Curve Analysis (DCA). 1215 patients (49% males, age 76 (71-81) years) were included. Follow-up was almost 7 years. Significant associations were found between vWF and cardiovascular events, stroke, mortality and bleeding. Based on IDI and NRI, addition of vWF to CHA₂DS₂-VASc statistically improved its predictive value, but c-indexes were not significantly different. For major bleeding, the addition of vWF to HAS-BLED improved the c-index but not IDI or NRI. DCA showed minimal net benefit. vWF acts as a simple prognostic biomarker in AF and, whilst its addition to current scores statistically improves prediction for some endpoints, absolute changes and impact on clinical decision-making are marginal.