Factors associated with disease progression in patients with atrial fibrillation and heart failure anticoagulated with rivaroxaban

Manito Lorite, Nicolás; Cepeda, José María (Cepeda Rodrigo); Farré López, Núria; Castillo Orive, Miguel; Galve, Enrique; Jiménez Candil, Javier; García Pinilla, José M.; López Sánchez, Eduardo Sebastián; Rafols, Carles; Gómez Doblas, Juan José

doi:http://dx.doi.org/10.1002/clc.24189

Factors associated with disease progression in patients with atrial fibrillation and heart failure anticoagulated with rivaroxaban

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Manito N, Cepeda-Rodrigo JM, Farré N, Castillo Orive M, Galve E, Jiménez-Candil J, et al. Factors associated with disease progression in patients with atrial fibrillation and heart failure anticoagulated with rivaroxaban. Clin Cardiol. 2024 Feb;47(2):e24189. DOI: 10.1002/clc.24189

Abstract

Background: Patients with atrial fibrillation (AF) and heart failure (HF) have a high risk of thromboembolism and other outcomes and anticoagulation is recommended. Hypothesis: This study was aimed to explore the risk factors associated with HF worsening in patients with AF and HF taking rivaroxaban in Spain. Methods: Multicenter, prospective, observational study that included adults with AF and chronic HF, receiving rivaroxaban ≥4 months before entering. HF worsening was defined as first hospitalization or emergency visit because of HF exacerbation. Results: A total of 672 patients from 71 Spanish centers were recruited, of whom 658 (97.9%) were included in the safety analysis and 552 (82.1%) in the per protocol analysis. At baseline, mean age was 73.7 ± 10.9 years, 64.9% were male, CHA2 DS2 -VASc was 4.1 ± 1.5, HAS-BLED was 1.6 ± 0.9% and 51.3% had HF with preserved ejection fraction. After 24 months of follow-up, 24.9% of patients developed HF worsening, 11.6% died, 2.9% had a thromboembolic event, 3.1% a major bleeding, 0.5% an intracranial bleeding and no patient had a fatal hemorrhage. Older age, the history of chronic obstructive pulmonary disease, the previous use of vitamin K antagonists, and restrictive or infiltrative cardiomyopathies, were independently associated with HF worsening. Only 6.9% of patients permanently discontinued rivaroxaban treatment. Conclusions: Approximately one out of four patients with HF and AF treated with rivaroxaban developed a HF worsening episode after 2 years of follow-up. The identification of those factors that increase the risk of HF worsening could be helpful in the comprehensive management of this population.