Quality of care and risk of incident atrial fibrillation in patients with newly diagnosed heart failure: a nationwide cohort study.

Vinter, Nicklas ORCID: 0000-0003-0558-8483, Cordsen, Pia, Fenger-Grøn, Morten, Lip, Gregory YH ORCID: 0000-0002-7566-1626, Benjamin, Emelia J ORCID: 0000-0003-4076-2336, Frost, Lars ORCID: 0000-0001-9215-9796 and Johnsen, Søren Paaske (2022) Quality of care and risk of incident atrial fibrillation in patients with newly diagnosed heart failure: a nationwide cohort study. European heart journal. Quality of care & clinical outcomes, 8 (5). pp. 539-547.

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Abstract

<h4>Aims</h4>Incident atrial fibrillation (AF) is an adverse prognostic indicator in heart failure (HF); identifying modifiable targets may be relevant to reduce the incidence and morbidity of AF. Therefore, we examined the association between quality of HF care and risk of AF.<h4>Methods and results</h4>Using the Danish Heart Failure Registry, we conducted a nationwide registry-based cohort study of all incident HF patients diagnosed between 2008 and 2018 and without history of AF. Quality of HF care was assessed by seven process performance measures, including echocardiographic examination, New York Heart Association classification, treatment with angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, beta-blockers, and mineralocorticoid antagonists, physical training, and patient education. In the main analysis, we examined adherence with all measures in a cohort of 25 100 patients (mean age 68.5 ± 13.2 years; 33.6% women). The median follow-up was 3.1 years. Cox proportional hazard regressions estimated the hazard ratios (HRs) with 95% confidence intervals (95% CIs) between the number of fulfilled measures and incident AF. In a multivariable-adjusted analysis with 0 fulfilled performance measures as reference, the HRs (95% CIs) were 1: 0.78 (0.61-1.00), 2: 0.63 (0.49-0.80), 3: 0.53 (0.36-0.80), 4: 0.64 (0.44-0.94), 5: 0.56 (0.39-0.82), 6: 0.51 (0.35-0.74), and 7: 0.49 (0.33-0.73), with a significant decreasing linear trend (P < 0.001).<h4>Conclusion</h4>In patients with incident HF, fulfilment of guideline-based process performance measures was associated with decreased long-term risk of AF. This study supports initiatives to improve the quality of care for patients with HF to prevent incident AF.

Item Type:	Article
Uncontrolled Keywords:	Humans, Atrial Fibrillation, Adrenergic beta-Antagonists, Cohort Studies, Aged, Aged, 80 and over, Middle Aged, Female, Male, Heart Failure, Angiotensin Receptor Antagonists
Divisions:	Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences
Depositing User:	Symplectic Admin
Date Deposited:	12 Oct 2023 15:43
Last Modified:	12 Oct 2023 15:43
DOI:	10.1093/ehjqcco/qcab036
Open Access URL:	https://www.ncbi.nlm.nih.gov/pmc/articles/PMC99895...
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3173657