Effects of Atrial Fibrillation on Heart Failure Outcomes and NT-proBNP Levels in the GUIDE-IT Trial

Fouad Chouairi; Justin Pacor; P Elliott Miller; Michael A Fuery; Cesar Caraballo; Sounok Sen; Eric S Leifer; G Michael Felker; Mona Fiuzat; Christopher M O'Connor; James L Januzzi; Daniel J Friedman; Nihar R Desai; Tariq Ahmad; James V Freeman

doi:10.1016/j.mayocpiqo.2021.02.005

Effects of Atrial Fibrillation on Heart Failure Outcomes and NT-proBNP Levels in the GUIDE-IT Trial

Mayo Clin Proc Innov Qual Outcomes. 2021 Apr 8;5(2):447-455. doi: 10.1016/j.mayocpiqo.2021.02.005. eCollection 2021 Apr.

Authors

Fouad Chouairi^{1

2}, Justin Pacor^{3

2}, P Elliott Miller¹, Michael A Fuery^{3

2}, Cesar Caraballo^{1

4}, Sounok Sen¹, Eric S Leifer⁵, G Michael Felker⁶, Mona Fiuzat⁶, Christopher M O'Connor⁷, James L Januzzi⁸, Daniel J Friedman^{1

4}, Nihar R Desai^{1

4}, Tariq Ahmad^{1

4}, James V Freeman^{1

4}

Affiliations

¹ Section of Cardiovascular Medicine, Yale University, New Haven, CT.
² Yale School of Medicine, Yale University, New Haven, CT.
³ Department of Internal Medicine, Yale University, New Haven, CT.
⁴ Center for Outcomes Research & Evaluation, Yale University, New Haven, CT.
⁵ Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD.
⁶ Duke Clinical Research Institute, Durham, NC.
⁷ Inova Heart and Vascular Institute, Falls Church, VA.
⁸ Massachusetts General Hospital, Boston.

Abstract

Objective: To evaluate effects of atrial fibrillation (AF) on cardiac biomarkers and outcomes in a trial population of patients with heart failure (HF) with reduced ejection fraction treated with optimal guideline-directed medical therapy.

Methods: We performed a secondary analysis of 894 patients in the Guiding Evidence-Based Therapy Using Biomarker-Intensified Treatment in Heart Failure (GUIDE-IT) trial (January 2013-July 2016). Patients were stratified by AF status and compared with regard to guideline-directed medical therapy use, longitudinal levels of N-terminal pro-B type natriuretic peptide (NT-proBNP), and outcomes including HF hospitalization and mortality.

Results: After adjustment, AF was associated with a significant increase in the risk of HF hospitalization or cardiovascular death (hazard ratio, 1.28; 95% CI, 1.02 to 1.61; P=0.04) and HF hospitalization (hazard ratio, 1.31; 95% CI, 1.02 to 1.68; P=.03) but with no difference in mortality during a median 15 months of follow-up. There were no significant differences in medication treatment between those with and those without AF. At 90 days, a higher proportion of patients with AF (89.4% vs 81.5%; P=.002) had an NT-proBNP level above 1000 pg/mL (to convert NT-proBNP values to pmol/L, multiply by 0.1182), and AF patients had higher NT-proBNP levels at all time points through 2 years of follow-up.

Conclusion: Among patients with HF with reduced ejection fraction, prevalent AF was associated with higher NT-proBNP concentrations through 2 years of follow-up and higher risk for HF hospitalization despite no substantial differences in medical therapy.

Keywords: AF, atrial fibrillation; CV, cardiovascular; GDMT, guideline-directed medical therapy; GUIDE-IT, Guiding Evidence-Based Therapy Using Biomarker-Intensified Treatment in Heart Failure trial; HF, heart failure; HFrEF, heart failure with reduced ejection fraction; KCCQ, Kansas City Cardiomyopathy Questionnaire; NT-proBNP, N-terminal pro–B type natriuretic peptide; RCT, randomized controlled trial.

Abstract

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