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

• Published in: Mayo Clinic proceedings. Innovations, quality & outcomes Vol. 5; no. 2; pp. 447 - 455
• Main Authors: Chouairi, Fouad, Pacor, Justin, Miller, P. Elliott, Fuery, Michael A., Caraballo, Cesar, Sen, Sounok, Leifer, Eric S., Felker, G. Michael, Fiuzat, Mona, O’Connor, Christopher M., Januzzi, James L., Friedman, Daniel J., Desai, Nihar R., Ahmad, Tariq, Freeman, James V.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.04.2021; Elsevier
• Subjects: Original; RCT; CV; NT-proBNP; AF; GDMT; KCCQ; GUIDE-IT; HFrEF; HF; KCCQ, Kansas City Cardiomyopathy Questionnaire; CV, cardiovascular; GDMT, guideline-directed medical therapy; AF, atrial fibrillation; HF, heart failure; RCT, randomized controlled trial; GUIDE-IT, Guiding Evidence-Based Therapy Using Biomarker-Intensified Treatment in Heart Failure trial; HFrEF, heart failure with reduced ejection fraction; NT-proBNP, N-terminal pro–B type natriuretic peptide
• ISSN: 2542-4548; 2542-4548
• DOI: 10.1016/j.mayocpiqo.2021.02.005

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. 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. 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. 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.