Pedro, Brigite, Mavropoulou, Antonia, Oyama, Mark A, Linney, Christopher, Neves, Joao, Dukes-McEwan, Joanna 
ORCID: 0000-0002-0326-8251, Fontes-Sousa, Ana P and Gelzer, Anna R
(2023)
Optimal rate control in dogs with atrial fibrillation-ORCA study-Multicenter prospective observational study: Prognostic impact and predictors of rate control.
JOURNAL OF VETERINARY INTERNAL MEDICINE, 37 (3).
pp. 887-899.
Abstract
<h4>Background</h4>The optimal heart rate (HR) in dogs with atrial fibrillation (AF) is unknown. Impact of HR on survival needs elucidation.<h4>Hypothesis/objectives</h4>Dogs with a 24 hours Holter-derived meanHR ≤125 beats per minute (bpm; rate controlled) survive longer than dogs with higher meanHR. We further aimed to determine which variables predict ability to achieving rate control.<h4>Animals</h4>Sixty dogs with AF.<h4>Methods</h4>Holter-derived meanHR, clinical, echocardiographic, and biomarker variables were analyzed prospectively. Survival was recorded from time of rate control, with all-cause mortality as primary endpoint. Cox proportional hazards analysis identified variables independently associated with survival; Kaplan-Meier survival analysis estimated the median survival time of dogs with meanHR ≤125 bpm vs >125 bpm. Logistic regression explored baseline variables associated with inability to achieve rate control.<h4>Results</h4>Structural heart disease was present in 56/60 dogs, 50/60 had congestive heart failure, and 45/60 died. Median time to all-cause death was 160 days (range, 88-303 days), dogs with meanHR >125 bpm (n = 27) lived 33 days (95% confidence interval [CI], 15-141 days), dogs with meanHR ≤125 bpm (n = 33) lived 608 days (95% CI, 155-880 days; P < .0001). Congenital heart disease and N-terminal pro-B-type natriuretic peptide were independently associated with higher risk of death (P < .01 and <.0001, respectively) whereas meanHR ≤125 bpm decreased the risk of death (P < .001). Increased left atrial size, increased C-reactive protein concentration and lower blood pressure at admission were associated with failure to achieve rate control.<h4>Conclusions and clinical importance</h4>Rate control affects survival; an optimal target meanHR <125 bpm should be sought in dogs with AF. Baseline patient variables can help predict if rate control is achievable.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | arrhythmia, biomarkers, echocardiography, Holter, survival |
| Divisions: | Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Infection, Veterinary and Ecological Sciences |
| Depositing User: | Symplectic Admin |
| Date Deposited: | 15 May 2023 07:38 |
| Last Modified: | 29 Jun 2023 06:30 |
| DOI: | 10.1111/jvim.16666 |
| Open Access URL: | https://onlinelibrary.wiley.com/doi/epdf/10.1111/j... |
| Related URLs: | |
| URI: | https://livrepository.liverpool.ac.uk/id/eprint/3170321 |
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