Mineralocorticoid Receptor Antagonism in Patients With Atrial Fibrillation: Findings From the ORBIT‐AF (Outcomes Registry for Better Informed Treatment of Atrial Fibrillation) Registry
BackgroundMineralocorticoid receptor antagonist (MRA) therapy may be beneficial to patients with atrial fibrillation (AF), but little is known about their use in patients with AF and subsequent outcomes. Methods and ResultsIn order to better understand MRA use and subsequent outcomes, we performed a...
| Main Authors: | , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2018-04-01
|
| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.117.007987 |
| _version_ | 1819178218811293696 |
|---|---|
| author | Marat Fudim Peter R. Liu Peter Shrader Rosalia G. Blanco Larry A. Allen Gregg C. Fonarow Bernard J. Gersh Peter R. Kowey Kenneth W. Mahaffey Elaine Hylek Alan S. Go Laine Thomas Eric D. Peterson Jonathan P. Piccini |
| author_facet | Marat Fudim Peter R. Liu Peter Shrader Rosalia G. Blanco Larry A. Allen Gregg C. Fonarow Bernard J. Gersh Peter R. Kowey Kenneth W. Mahaffey Elaine Hylek Alan S. Go Laine Thomas Eric D. Peterson Jonathan P. Piccini |
| author_sort | Marat Fudim |
| collection | DOAJ |
| description | BackgroundMineralocorticoid receptor antagonist (MRA) therapy may be beneficial to patients with atrial fibrillation (AF), but little is known about their use in patients with AF and subsequent outcomes. Methods and ResultsIn order to better understand MRA use and subsequent outcomes, we performed a retrospective cohort study of the contemporary ORBIT‐AF (Outcomes Registry for Better Informed Treatment of Atrial Fibrillation) registry. AF progression and cardiovascular outcomes were compared using propensity‐matched Cox proportional hazards modeling according to MRA use at baseline and new MRA use at follow‐up versus patients with no MRA use. Among 7012 patients with nonpermanent AF, 320 patients were taking MRA at enrollment, and 416 patients initiated MRA use during follow‐up. The mean patient age was 72.5 years, 56.3% were men, and 70.4% had paroxysmal AF. Among all patients taking MRAs, 434 (59.0%) had heart failure, 655 (89.0%) had hypertension, and 380 (51.6%) had both. After adjustment, new MRA use was not associated with reduced AF progression (hazard ratio, 1.18; 95% confidence interval, 0.88–1.58; P=0.27) but showed a trend towards lower risk of stroke, transient ischemic attack, or systemic embolism (hazard ratio, 0.17; 95% confidence interval, 0.02–1.23; P=0.08). Results were similar for a comparison of new MRA users and baseline MRA users compared with nonusers. ConclusionsIn community‐based outpatients with AF, the majority of MRA use was for heart failure and hypertension. MRA use also trended towards lower adjusted stroke risk. Future studies should test the hypothesis that MRA use may decrease the risk of stroke in patients with AF. |
| first_indexed | 2024-12-22T21:39:04Z |
| format | Article |
| id | doaj.art-eb51a26d0f394ca0bdfc303ffb378af9 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-22T21:39:04Z |
| publishDate | 2018-04-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-eb51a26d0f394ca0bdfc303ffb378af92022-12-21T18:11:40ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802018-04-017810.1161/JAHA.117.007987Mineralocorticoid Receptor Antagonism in Patients With Atrial Fibrillation: Findings From the ORBIT‐AF (Outcomes Registry for Better Informed Treatment of Atrial Fibrillation) RegistryMarat Fudim0Peter R. Liu1Peter Shrader2Rosalia G. Blanco3Larry A. Allen4Gregg C. Fonarow5Bernard J. Gersh6Peter R. Kowey7Kenneth W. Mahaffey8Elaine Hylek9Alan S. Go10Laine Thomas11Eric D. Peterson12Jonathan P. Piccini13Division of Cardiology, Duke Clinical Research Institute, Durham, NCDivision of Cardiology, Duke Clinical Research Institute, Durham, NCDivision of Cardiology, Duke Clinical Research Institute, Durham, NCDivision of Cardiology, Duke Clinical Research Institute, Durham, NCUniversity of Colorado School of Medicine, Aurora, CORonald Reagan‐UCLA Medical Center, Los Angeles, CAMayo Clinic College of Medicine Mayo Clinic, Rochester, MNLankenau Institute for Medical Research, Wynnewood, PAStanford University School of Medicine, Palo Alto, CABoston University School of Medicine, Boston, MAKaiser Permanente Northern California, Oakland, CADivision of Cardiology, Duke Clinical Research Institute, Durham, NCDivision of Cardiology, Duke Clinical Research Institute, Durham, NCDivision of Cardiology, Duke Clinical Research Institute, Durham, NCBackgroundMineralocorticoid receptor antagonist (MRA) therapy may be beneficial to patients with atrial fibrillation (AF), but little is known about their use in patients with AF and subsequent outcomes. Methods and ResultsIn order to better understand MRA use and subsequent outcomes, we performed a retrospective cohort study of the contemporary ORBIT‐AF (Outcomes Registry for Better Informed Treatment of Atrial Fibrillation) registry. AF progression and cardiovascular outcomes were compared using propensity‐matched Cox proportional hazards modeling according to MRA use at baseline and new MRA use at follow‐up versus patients with no MRA use. Among 7012 patients with nonpermanent AF, 320 patients were taking MRA at enrollment, and 416 patients initiated MRA use during follow‐up. The mean patient age was 72.5 years, 56.3% were men, and 70.4% had paroxysmal AF. Among all patients taking MRAs, 434 (59.0%) had heart failure, 655 (89.0%) had hypertension, and 380 (51.6%) had both. After adjustment, new MRA use was not associated with reduced AF progression (hazard ratio, 1.18; 95% confidence interval, 0.88–1.58; P=0.27) but showed a trend towards lower risk of stroke, transient ischemic attack, or systemic embolism (hazard ratio, 0.17; 95% confidence interval, 0.02–1.23; P=0.08). Results were similar for a comparison of new MRA users and baseline MRA users compared with nonusers. ConclusionsIn community‐based outpatients with AF, the majority of MRA use was for heart failure and hypertension. MRA use also trended towards lower adjusted stroke risk. Future studies should test the hypothesis that MRA use may decrease the risk of stroke in patients with AF.https://www.ahajournals.org/doi/10.1161/JAHA.117.007987atrial fibrillationmineralocorticoid antagoniststroke |
| spellingShingle | Marat Fudim Peter R. Liu Peter Shrader Rosalia G. Blanco Larry A. Allen Gregg C. Fonarow Bernard J. Gersh Peter R. Kowey Kenneth W. Mahaffey Elaine Hylek Alan S. Go Laine Thomas Eric D. Peterson Jonathan P. Piccini Mineralocorticoid Receptor Antagonism in Patients With Atrial Fibrillation: Findings From the ORBIT‐AF (Outcomes Registry for Better Informed Treatment of Atrial Fibrillation) Registry Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease atrial fibrillation mineralocorticoid antagonist stroke |
| title | Mineralocorticoid Receptor Antagonism in Patients With Atrial Fibrillation: Findings From the ORBIT‐AF (Outcomes Registry for Better Informed Treatment of Atrial Fibrillation) Registry |
| title_full | Mineralocorticoid Receptor Antagonism in Patients With Atrial Fibrillation: Findings From the ORBIT‐AF (Outcomes Registry for Better Informed Treatment of Atrial Fibrillation) Registry |
| title_fullStr | Mineralocorticoid Receptor Antagonism in Patients With Atrial Fibrillation: Findings From the ORBIT‐AF (Outcomes Registry for Better Informed Treatment of Atrial Fibrillation) Registry |
| title_full_unstemmed | Mineralocorticoid Receptor Antagonism in Patients With Atrial Fibrillation: Findings From the ORBIT‐AF (Outcomes Registry for Better Informed Treatment of Atrial Fibrillation) Registry |
| title_short | Mineralocorticoid Receptor Antagonism in Patients With Atrial Fibrillation: Findings From the ORBIT‐AF (Outcomes Registry for Better Informed Treatment of Atrial Fibrillation) Registry |
| title_sort | mineralocorticoid receptor antagonism in patients with atrial fibrillation findings from the orbit af outcomes registry for better informed treatment of atrial fibrillation registry |
| topic | atrial fibrillation mineralocorticoid antagonist stroke |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.117.007987 |
| work_keys_str_mv | AT maratfudim mineralocorticoidreceptorantagonisminpatientswithatrialfibrillationfindingsfromtheorbitafoutcomesregistryforbetterinformedtreatmentofatrialfibrillationregistry AT peterrliu mineralocorticoidreceptorantagonisminpatientswithatrialfibrillationfindingsfromtheorbitafoutcomesregistryforbetterinformedtreatmentofatrialfibrillationregistry AT petershrader mineralocorticoidreceptorantagonisminpatientswithatrialfibrillationfindingsfromtheorbitafoutcomesregistryforbetterinformedtreatmentofatrialfibrillationregistry AT rosaliagblanco mineralocorticoidreceptorantagonisminpatientswithatrialfibrillationfindingsfromtheorbitafoutcomesregistryforbetterinformedtreatmentofatrialfibrillationregistry AT larryaallen mineralocorticoidreceptorantagonisminpatientswithatrialfibrillationfindingsfromtheorbitafoutcomesregistryforbetterinformedtreatmentofatrialfibrillationregistry AT greggcfonarow mineralocorticoidreceptorantagonisminpatientswithatrialfibrillationfindingsfromtheorbitafoutcomesregistryforbetterinformedtreatmentofatrialfibrillationregistry AT bernardjgersh mineralocorticoidreceptorantagonisminpatientswithatrialfibrillationfindingsfromtheorbitafoutcomesregistryforbetterinformedtreatmentofatrialfibrillationregistry AT peterrkowey mineralocorticoidreceptorantagonisminpatientswithatrialfibrillationfindingsfromtheorbitafoutcomesregistryforbetterinformedtreatmentofatrialfibrillationregistry AT kennethwmahaffey mineralocorticoidreceptorantagonisminpatientswithatrialfibrillationfindingsfromtheorbitafoutcomesregistryforbetterinformedtreatmentofatrialfibrillationregistry AT elainehylek mineralocorticoidreceptorantagonisminpatientswithatrialfibrillationfindingsfromtheorbitafoutcomesregistryforbetterinformedtreatmentofatrialfibrillationregistry AT alansgo mineralocorticoidreceptorantagonisminpatientswithatrialfibrillationfindingsfromtheorbitafoutcomesregistryforbetterinformedtreatmentofatrialfibrillationregistry AT lainethomas mineralocorticoidreceptorantagonisminpatientswithatrialfibrillationfindingsfromtheorbitafoutcomesregistryforbetterinformedtreatmentofatrialfibrillationregistry AT ericdpeterson mineralocorticoidreceptorantagonisminpatientswithatrialfibrillationfindingsfromtheorbitafoutcomesregistryforbetterinformedtreatmentofatrialfibrillationregistry AT jonathanppiccini mineralocorticoidreceptorantagonisminpatientswithatrialfibrillationfindingsfromtheorbitafoutcomesregistryforbetterinformedtreatmentofatrialfibrillationregistry |