PMID- 15767288
OWN - NLM
STAT- MEDLINE
DCOM- 20051013
LR  - 20181201
IS  - 0195-668X (Print)
IS  - 0195-668X (Linking)
VI  - 26
IP  - 13
DP  - 2005 Jul
TI  - Prognostic relevance of atrial fibrillation in patients with chronic heart 
      failure on long-term treatment with beta-blockers: results from COMET.
PG  - 1303-8
AB  - AIMS: Atrial fibrillation is common in patients with chronic heart failure (CHF). 
      We analysed the risk associated with atrial fibrillation in a large cohort of 
      patients with chronic heart failure all treated with a beta-blocker. METHODS AND 
      RESULTS: In COMET, 3029 patients with CHF were randomized to carvedilol or 
      metoprolol tartrate and followed for a mean of 58 months. We analysed the 
      prognostic relevance on other outcomes of atrial fibrillation on the baseline 
      electrocardiogram compared with no atrial fibrillation and the impact of new 
      onset atrial fibrillation during follow-up. A multivariate analysis was performed 
      using a Cox regression model where 10 baseline covariates were entered together 
      with study treatment allocation. Six hundred patients (19.8%) had atrial 
      fibrillation at baseline. These patients were older (65 vs. 61 years), included 
      more men (88 vs.78%), had more severe symptoms [higher New York Heart Association 
      (NYHA) class] and a longer duration of heart failure (all P<0.0001). Atrial 
      fibrillation was associated with significantly increased mortality [relative risk 
      (RR) 1.29: 95% CI 1.12-1.48; P<0.0001], higher all-cause death or hospitalization 
      (RR 1.25: CI 1.13-1.38), and cardiovascular death or hospitalization for 
      worsening heart failure (RR 1.34: CI 1.20-1.52), both P<0.0001. By multivariable 
      analysis, atrial fibrillation no longer independently predicted mortality. 
      Beneficial effects on mortality by carvedilol remained significant (RR 0.836: CI 
      0.74-0.94; P=0.0042). New onset atrial fibrillation during follow-up (n=580) was 
      associated with significant increased risk for subsequent death in a 
      time-dependent analysis (RR 1.90: CI 1.54-2.35; P<0.0001) regardless of treatment 
      allocation and changes in NYHA class. CONCLUSION: In CHF, atrial fibrillation 
      significantly increases the risk for death and heart failure hospitalization, but 
      is not an independent risk factor for mortality after adjusting for other 
      predictors of prognosis. Treatment with carvedilol compared with metoprolol 
      offers additional benefits among patients with atrial fibrillation. Onset of new 
      atrial fibrillation in patients on long-term beta-blocker therapy is associated 
      with significant increased subsequent risk of mortality and morbidity.
FAU - Swedberg, Karl
AU  - Swedberg K
AD  - Department of Medicine, Sahlgrenska University Hospital/Ostra, SE-416 85 
      Goteborg, Sweden. karl.swedberg@hjl.gu.se
FAU - Olsson, Lars G
AU  - Olsson LG
FAU - Charlesworth, Andrew
AU  - Charlesworth A
FAU - Cleland, John
AU  - Cleland J
FAU - Hanrath, Peter
AU  - Hanrath P
FAU - Komajda, Michel
AU  - Komajda M
FAU - Metra, Marco
AU  - Metra M
FAU - Torp-Pedersen, Christian
AU  - Torp-Pedersen C
FAU - Poole-Wilson, Philip
AU  - Poole-Wilson P
LA  - eng
PT  - Clinical Trial
PT  - Journal Article
PT  - Randomized Controlled Trial
DEP - 20050314
PL  - England
TA  - Eur Heart J
JT  - European heart journal
JID - 8006263
RN  - 0 (Adrenergic beta-Antagonists)
RN  - 0 (Carbazoles)
RN  - 0 (Propanolamines)
RN  - 0K47UL67F2 (Carvedilol)
RN  - GEB06NHM23 (Metoprolol)
SB  - IM
CIN - Eur Heart J. 2006 Jan;27(2):247. PMID: 16311238
MH  - Adrenergic beta-Antagonists/*therapeutic use
MH  - Aged
MH  - Atrial Fibrillation/*etiology/mortality
MH  - Carbazoles/*therapeutic use
MH  - Carvedilol
MH  - Double-Blind Method
MH  - Electrocardiography
MH  - Female
MH  - Heart Failure/complications/*drug therapy/mortality
MH  - Humans
MH  - Long-Term Care
MH  - Male
MH  - Metoprolol/*therapeutic use
MH  - Middle Aged
MH  - Prognosis
MH  - Propanolamines/*therapeutic use
MH  - Ventricular Dysfunction, Left/etiology/mortality
EDAT- 2005/03/16 09:00
MHDA- 2005/10/14 09:00
CRDT- 2005/03/16 09:00
PHST- 2005/03/16 09:00 [pubmed]
PHST- 2005/10/14 09:00 [medline]
PHST- 2005/03/16 09:00 [entrez]
AID - ehi166 [pii]
AID - 10.1093/eurheartj/ehi166 [doi]
PST - ppublish
SO  - Eur Heart J. 2005 Jul;26(13):1303-8. doi: 10.1093/eurheartj/ehi166. Epub 2005 Mar 
      14.