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Proton pump inhibitors in patients with atrial fibrillation and new-onset acute heart failure
Session:
Painel 5 -Arritmologia 2
Speaker:
João Baltazar Ferreira
Congress:
CPC 2020
Topic:
C. Arrhythmias and Device Therapy
Theme:
05. Atrial Fibrillation
Subtheme:
05.4 Atrial Fibrillation - Treatment
Session Type:
Posters
FP Number:
---
Authors:
João Baltazar Ferreira; J. Augusto; M. Santos; D. Roque; D. Faria; H. Ferreira; C. Morais
Abstract
<p><u>Background</u></p> <p>Proton pump inhibitors (PPIs) are frequently used among patients with atrial fibrillation (AF). In patients under PPI therapy, anaemia due to both iron and vitamin B12 deficiencies may ensue. </p> <p><u>Purpose</u></p> <p>We aimed to evaluate the incidence of hospitalization for de novo acute heart failure (AHF) at 12-month follow-up in patients with atrial fibrillation who were under PPI therapy. </p> <p><u>Methods</u></p> <p>We included retrospectively 2181 consecutive patients with AF who were evaluated in our Emergency Department (ED) in a 12 month period. Among them, 423 patients were admitted for in-hospital management. Patients who had previous known heart failure (n=101), who were under antiplatelet therapy (aspirin, clopidogrel and/or ticagrelor) (n=109) and those with history of dyspepsia, gastroesophageal reflux, peptic ulcer disease or gastrointestinal bleeding (n=30) were excluded. We recorded the haematocrit (Htc) nadir during in-hospital stay. We further determined the proportion of PPI prescription at discharge. Primary outcome was the incidence of hospitalization for de novo AHF 12 months after discharge. </p> <p><u>Results</u></p> <p>We included 172 AF patients who were successfully discharged and followed for 12 months (mean age of 69.3 ± 12.8 years, 37.2% males). A total of 30.8% (n=53) had a PPI prescription at discharge. In all of these cases, PPIs were also prescribed during in-hospital stay. Nadir Htc during hospitalization was significantly lower in patients under PPI therapy (median of 37.4 vs. 40.4%; p=0.003). Kaplan-Meier analysis (Figure) showed that patients with AF who were taking PPIs had a higher incidence of de novo AHF 12 months after discharge (23.1 vs. 7.6%; log-rank p=0.004). Cox regression analysis controlled for age and chronic kidney disease showed that PPI therapy was an independent predictor of de novo AHF (HR 2.90; CI 95% 1.22 – 6.90; p=0.016).</p> <p><u>Conclusions</u></p> <p>Approximately one third of the AF patients were treated with PPI, the vast majority without formal indication. PPI overuse was associated with anaemia and hospitalization for de novo acute heart failure and therefore its use must be carefully weighted in clinical practice.</p>
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