CORRESPONDENCE: LETTER TO THE EDITOR
Reply
Lars Olsson, MB,
Marc A. Pfeffer, MD, PhD, FACC and
Karl Swedberg, MD, FACC*
* Department of Medicine, Sahlgrenska University Hospital/Östra, SE-416 85 Göteborg, Sweden (Email: karl.swedberg{at}gu.se).
Drs. Parkash and Stevenson relate that in their experiences the survival of patients with both atrial fibrillation (AF) and heart failure (HF) was similarly impaired whether the ejection fraction was depressed or preserved in patients hospitalized for HF. Of interest, although in the CHARM (Candesartan in Heart failure-Assessment of Reduction in mortality and morbidity) study there was an overall better survival in those patients with preserved ejection fraction (1), the presence of AF in those patients had a greater negative impact (2), raising the suggestion that AF tends to equalize the risk in patients with low compared with preserved ejection fractions. There was an increased risk with new-onset AF, and patients with low ejection fraction had the worst prognosis, but we could not assess the time-dependence of this risk. We have previously reported the time-dependent relationship with new-onset AF and subsequent increased risk in another patient population with chronic heart failure (3).
Parkash and Stevenson also raise the intriguing possibility that an anti-inflammatory action of a statin in patients with both AF and HF may improve outcome. In CHARM, the results were adjusted for baseline variables but not for baseline concomitant treatment, as causality and selection bias for treatments are impossible to distinguish in such a trial (4).
The ongoing CORONA (Controlled Rosuvastatin Multinational Study in Heart Failure) trial has randomized patients with symptomatic HF to either placebo or rosuvastatin (5). Because 24% of the enrolled patients have AF at baseline and more will develop AF during the study, analysis of this randomized trial data will undoubtedly provide more definitive information regarding the effects of a statin in patients with both AF and HF.
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References
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- Solomon SD, Anavekar N, Skali H, et al. CHARM Investigators Influence of ejection fraction on cardiovascular outcomes in a broad spectrum of heart failure patients Circulation 2005;112:3738-3744.[Abstract/Free Full Text]
- Olsson LG, Swedberg K, Ducharme A, et al. Atrial fibrillation and risk of clinical events in chronic heart failure with and without left ventricular systolic dysfunction: results from the Candesartan in Heart failure-Assessment of Reduction in Mortality and morbidity (CHARM) program J Am Coll Cardiol 2006;47:1997-2004.[Abstract/Free Full Text]
- Swedberg K, Olsson LG, Charlesworth A, et al. Prognostic relevance of atrial fibrillation in patients with chronic heart failure on long-term treatment with beta-blockers: results from COMET Eur Heart J 2005;26:1303-1308.[Abstract/Free Full Text]
- Pocock SJ, Wang D, Pfeffer MA, et al. Predictors of mortality and morbidity in patients with chronic heart failure Eur Heart J 2006;27:65-75.[Abstract/Free Full Text]
- Kjekshus J, Dunselman P, Blideskog M, et al. A statin in the treatment of heart failure?Controlled rosuvastatin multinational study in heart failure (CORONA): study design and baseline characteristics. Eur J Heart Fail 2005;7:1059-1069.[CrossRef][ISI][Medline]
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