Archives of the Turkish Society of Cardiology
Comparison of clinical characteristics of patients with heart failure and preserved ejection fraction with atrial fibrillation versus sinus rhythm: Insights from the APOLLON registry [Turk Kardiyol Dern Ars]
Turk Kardiyol Dern Ars. 2020; 48(3): 234-245 | DOI: 10.5543/tkda.2019.77236

Comparison of clinical characteristics of patients with heart failure and preserved ejection fraction with atrial fibrillation versus sinus rhythm: Insights from the APOLLON registry

Bülent Özlek1, Eda Özlek1, Mehmet Tekinalp2, Serkan Kahraman3, Hicaz Zencirkiran Agus3, Özcan Başaran1, Bedri Caner Kaya4, İbrahim Rencüzoğulları5, Kadir Ugur Mert6, Ozan Çakır7, Altuğ Ösken8, Lütfü Bekar9, Yunus Çelik10, Cem Çil1, Volkan Doğan1, Oğuzhan Çelik1, Gurbet Özge Mert11, Kadriye Memiç Sancar3, Samet Sevinç3, Murat Biteker1
1Department of Cardiology, Muğla Sıtkı Koçman University Faculty of Medicine, Muğla, Turkey
2Department of Cardiology, Necip Fazıl City Hospital, Kahramanmaraş, Turkey
3Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
4Department of Cardiology, Mehmet Akif İnan Training and Research Hospital, Şanlıurfa, Turkey
5Department of Cardiology, Kafkas University Faculty of Medicine, Kars, Turkey
6Department of Cardiology, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
7Department of Cardiology, Bülent Ecevit University Faculty of Medicine, Zonguldak, Turkey
8Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
9Department of Cardiology, Hitit University Çorum Erol Olçok Training and Research Hospital, Çorum, Turkey
10Department of Cardiology, Kırıkkale Yüksek İhtisas Hospital, Kırıkkale, Turkey
11Department of Cardiology, Yunus Emre State Hospital, Eskişehir, Turkey


OBJECTIVE
The aim of this study was to assess the clinical characteristics of patients with heart failure and preserved ejection fraction (HFpEF) and atrial fibrillation (AF) and compare them with those of HFpEF patients without AF.

METHODS
This study was a sub-group analysis of a multicenter, observational, and cross-sectional registry conducted in Turkey (ClinicalTrials.gov identifier: NCT03026114). Patients with HFpEF were divided into 2 groups: HFpEF with AF and HFpEF with sinus rhythm (SR), and the clinical characteristics of the groups were compared.

RESULTS
In a total of 819 HFpEF patients (median age: 67 years; 58% women), 313 (38.2%) had AF. Compared to the patients with SR, those with AF were older (70 years vs 66 years; p<0.001) and more symptomatic, with a higher rate of classification as New York Heart Association functional class III-IV, paroxysmal nocturnal dyspnea, orthopnea, palpitations, fatigue, pulmonary crepitations, and peripheral edema. The hospitalization rate for heart failure was higher (28.4% vs 12.6%; p<0.001) in patients with AF, and participants with AF had higher level of N-terminal pro-B-type natriuretic peptide (887 pg/mL vs 394.8 pg/mL; p<0.001) and higher left atrial volume index level. Patients without AF had a higher burden of diabetes mellitus, obstructive sleep apnea, and coronary artery disease. The prescription rate of nondihydropyridine calcium blockers, digoxin, loop diuretics, and anticoagulant drugs was higher in the AF group.

CONCLUSION
The results of this study revealed that in a large Turkish cohort with HFpEF, significant clinical differences were present between those with and without AF and. Further prospective studies are needed to clarify the prognostic implications of AF in this growing heart failure population in our country.

Keywords: Atrial fibrillation, clinical differences; heart failure with preserved ejection fraction; sinus rhythm; Turkey.

How to cite this article
Bülent Özlek, Eda Özlek, Mehmet Tekinalp, Serkan Kahraman, Hicaz Zencirkiran Agus, Özcan Başaran, Bedri Caner Kaya, İbrahim Rencüzoğulları, Kadir Ugur Mert, Ozan Çakır, Altuğ Ösken, Lütfü Bekar, Yunus Çelik, Cem Çil, Volkan Doğan, Oğuzhan Çelik, Gurbet Özge Mert, Kadriye Memiç Sancar, Samet Sevinç, Murat Biteker. Comparison of clinical characteristics of patients with heart failure and preserved ejection fraction with atrial fibrillation versus sinus rhythm: Insights from the APOLLON registry. Turk Kardiyol Dern Ars. 2020; 48(3): 234-245

Corresponding Author: Bülent Özlek, Türkiye
© Copyright 2020 Archives of the Turkish Society of Cardiology
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