Impact of heart failure on the clinical profile and outcomes in patients with atrial fibrillation treated with rivaroxaban. Data from the EMIR study

Abstract

Background:The aim of this study was to analyze the impact of the presence of heart failure (HF) on the clinical profile and outcomes in patients with atrial fibrillation (AF) anticoagulated with rivaroxaban.Methods: Observational and non-interventional study that included AF adults recruited from 79 Spanish centers, anticoagulated with rivaroxaban ≥ 6 months before inclusion.Data were analyzed according to baseline HF status.Results: Out of 1,433 patients, 326 (22.7%) had HF at baseline. Compared to patients without HF, HF patients were older (75.3 ± 9.9 vs. 73.8 ± 9.6 years; p = 0.01), had more diabetes (36.5% vs. 24.3%; p < 0.01), coronary artery disease (28.2% vs. 12.9%; p < 0.01), renal insufficiency (31.7% vs. 22.6%; p = 0.01), higher CHA 2 DS 2 -VASc (4.5 ± 1.

Outcomes and factors associated with mortality in patients with atrial fibrillation and heart failure: FARAONIC study

“…In our study, nearly 12% of patients had died at the end of the follow‐up. In the subgroup of HF patients taking rivaroxaban in the ROCKET‐AF trial, the rate of all‐cause death was 5.1 events per 100 patient‐years 11 and in the HF population of the EMIR study, the annual rate of death was 5.5% 18 . As a result, our data were consistent with previous studies.…”

“… 17 This was also in line with the subgroup of patients with HF included in the EMIR study, a Spanish registry of patients with AF treated with rivaroxaban in clinical practice. 18 As a result, our data are representative of anticoagulated patients with HF and AF. On the other hand, previous studies have shown that within the overall HF population, the proportion of patients with HF with reduced ejection fraction is higher than that observed in our study.…”

“…In the subgroup of HF patients taking rivaroxaban in the ROCKET‐AF trial, the rate of intracranial hemorrhage was 0.40 events per 100 patient years 11 . In the EMIR study, a real‐world prospective registry of AF patients taking rivaroxaban in Spain, among patients with HF, annual rate of major bleeding was 1.4% 18 . Remarkably, a study performed in AF patients at high risk for falls, treatment with rivaroxaban was associated with a marked reduction of intracranial hemorrhage compared to warfarin 24 .…”

“…In the subgroup of HF patients taking rivaroxaban in the ROCKET‐AF trial, the rate of stroke or systemic embolization was 1.9 events per 100 patient‐years and the rate of myocardial infarction was 1.1 events per 100 patient‐years 11 . Among those patients with HF included in the EMIR study, the annual rates of thromboembolic events (stroke + systemic embolism + transient ischemic attack) and major cardiovascular events were 1.2% and 3.0%, respectively 18 . All these data clearly suggest that although AF patients with HF (vs. no HF) have a higher risk of adverse events, 11,18 incidences of thromboembolic complications and myocardial infarction are very low among patients treated with rivaroxaban.…”

“…11 Among those patients with HF included in the EMIR study, the annual rates of thromboembolic events (stroke + systemic embolism + transient ischemic attack) and major cardiovascular events were 1.2% and 3.0%, respectively. 18 All these T A B L E 2 Hospitalizations and/or visits to the emergency department during the follow-up.…”