SIB #447- Inflammation, A-Fib and Heart Failure

 

The Study: Biomarkers of Inflammation and Risk of Hospitalization for Heart Failure in Patients with Atrial Fibrillation.

Overview: This is a prospective study of patients with established Atrial Fibrillation (AF) which compared their biomarkers for inflammation with the risk of hospitalization due to heart failure.

 

Key Points:

  •  “Heart failure and AF are closely linked, and both conditions often occur concurrently, predisposing affected patients to poor outcomes.”

  • Heart failure accounts for a substantial proportion of deaths in patients with AF and the incidence of heart failure in AF patients has not changed over the past 20 plus years despite advances in anticoagulation therapies.

  •  Additionally, biomarkers of inflammation have been associated with the incidence of atherothrombotic events in multiple populations,

  •  In an attempt to identify patients with potentially modifiable risk factors for heart failure, a large cohort of (3784 patients with a media age of 72 years) with established Atrial Fibrillation was followed for four years.

  •  “Patients with AF due to reversible, secondary causes (eg, perioperative AF or AF due to severe electrolyte abnormalities) were excluded. “

  •  Levels of two biomarkers of inflammation; high sensitivity C-reactive protein (hs-CRP) and Interleukin-6 (Il-6) were established at the outset of the study from plasma samples..

  •  “Patients with any acute illness or who were hospitalized for any reason (factors which might skew markers of inflammation) could be enrolled only at least 4 weeks after the acute episode or hospital discharge.” (Parenthesis/Italics ours)

  •  “Plasma levels of both hs‐CRP and IL‐6 were used to calculate a simple, prespecified inflammation score ranging from 0 to 4 (1 point for each biomarker between the 50th and 75th percentile, 2 points for each biomarker above the 75th percentile).”

   

Author’s Conclusions:

   “biomarkers of inflammation (hs‐CRP [high‐sensitivity C‐reactive protein], interleukin‐6) were strongly associated with hospitalization for heart failure and other adverse outcomes during a median follow‐up duration of 4.0 years.”

 “Large absolute risk differences for a first hospitalization for heart failure were observed across different categories of inflammation.”  (eg, both hs‐CRP and interleukin‐6 above the 75th percentile versus both biomarkers up to or below the 50th percentile, incidence 7.31 versus 1.34 per 100 person‐years) 

  

Reviewer's Comments: When both hs-CRP and Il-6 were above the 75th percentile, patients in the cohort were nearly 5 ½ times as likely to be hospitalized for heart failure. While proving causality is always difficult, this study seems to be in keeping with an increasing body of evidence that chronic inflammation is associated with a wide range of human ailments. The good news is that chronic inflammation is potentially modifiable with changes in lifestyle.

 

Reviewer:  Mark R. Payne DC 

 

Reference:  Alexander P. Benz, Stefanie Aeschbacher,Philipp Krisai et al. Biomarkers of Inflammation and Risk of Hospitalization for Heart Failure in Patients With Atrial Fibrillation.  Apr 10, 2021  Journal of the American Heart Association.

  

Link to Full Text: https://doi.org/10.1161/JAHA.120.019168

 

Mark R. Payne DC