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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Left ventricular systolic dysfunction, heart failure, and the risk of stroke and systemic embolism in patients with atrial fibrillation insights from the ARISTOTLE trial
Circulation: Heart Failure, Volume 6, No. 3, Year 2013
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Description
Background-We examined the risk of stroke or systemic embolism (SSE) conferred by heart failure (HF) and left ventricular systolic dysfunction (LVSD) in the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation Trial (ARISTOTLE), as well as the effect of apixaban versus warfarin. Methods and Results-The risk of a number of outcomes, including the composite of SSE or death (to take account of competing risks) and composite of SSE, major bleeding, or death (net clinical benefit) were calculated in 3 patient groups: (1) no HF/no LVSD (n=8728), (2) HF/no LVSD (n=3207), and (3) LVSD with/without symptomatic HF (n=2736). The rate of both outcomes was highest in patients with LVSD (SSE or death 8.06; SSE, major bleeding, or death 10.46 per 100 patient-years), intermediate for HF but preserved LV systolic function (5.32; 7.24), and lowest in patients without HF or LVSD (1.54; 5.27); each comparison P<0.0001. Each outcome was less frequent in patients treated with apixaban: in all ARISTOTLE patients, the apixaban/warfarin hazard ratio for SSE or death was 0.89 (95% confidence interval, 0.81-0.98; P=0.02); for SSE, major bleed, or death it was 0.85 (0.78-0.92; P<0.001). There was no heterogeneity of treatment effect across the 3 groups. Conclusions-Patients with LVSD (with/without HF) had a higher risk of SSE or death (but similar rate of SSE) compared with patients with HF but preserved LV systolic function; both had a greater risk than patients without either HF or LVSD. Apixaban reduced the risk of both outcomes more than warfarin in all 3 patient groups. © 2013 American Heart Association, Inc.
Authors & Co-Authors
McMurray, John JV
United Kingdom, Glasgow
Glasgow Cardiovascular Research Centre
Ezekowitz, Justin A.
Canada, Edmonton
University of Alberta
Lewis, Basil S.
Israel, Haifa
Carmel Medical Center
Gersh, Bernard John
United States, Rochester
Mayo Medical School
Van-Diepen, Sean F.P.
Canada, Edmonton
University of Alberta
Amerena, John V.
Australia, Geelong
Deakin University
Bartúnek, Jozef J.
Belgium, Aalst
Onze Lieve Vrouw Hospital
Commerford, Patrick Joseph
South Africa, Cape Town
University of Cape Town
Oh, Byunghee Heeh
South Korea, Seoul
Seoul National University Hospital
Harjola, Veli Pekka
Finland, Helsinki
Helsinki University Hospital
Al-Khatib, Sana M.
United States, Durham
Duke Clinical Research Institute
Hanna, Michael S.
United States, New York
Bristol-myers Squibb
Alexander, John H.P.
United States, Durham
Duke Clinical Research Institute
Lópes, Renato Deláscio
United States, Durham
Duke Clinical Research Institute
Wojdyla, Daniel
United States, Durham
Duke Clinical Research Institute
Wallentin, Lars
Sweden, Uppsala
Uppsala Universitet
Granger, Christopher B.
United States, Durham
Duke Clinical Research Institute
Statistics
Citations: 144
Authors: 17
Affiliations: 12
Identifiers
Doi:
10.1161/CIRCHEARTFAILURE.112.000143
ISSN:
19413289
e-ISSN:
19413297
Research Areas
Environmental
Genetics And Genomics
Health System And Policy
Noncommunicable Diseases
Study Design
Quasi Experimental Study