Evidence map›Paper›PMID 39968941›Full record

ArticleESC heart failure2025

Up-titration of medication in patients with new-onset heart failure with and without atrial fibrillation.

Arietje J L Zandijk, Bernadet T Santema, Friso D J Inkelaar, Martje H L van der Wal, Janke Warink-Riemersma, Michiel Rienstra, Adriaan A Voors

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in ESC heart failure, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Arietje J L ZandijkDepartment of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Bernadet T SantemaDepartment of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Friso D J InkelaarDepartment of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Martje H L van der WalDepartment of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Janke Warink-RiemersmaDepartment of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Michiel RienstraDepartment of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Adriaan A VoorsDepartment of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

aimsDifferences in guideline-directed medical therapy (GDMT) and clinical outcomes have been observed between heart failure (HF) patients with atrial fibrillation (AF) versus those in sinus rhythm. This study evaluated the effects of up-titration of HF therapies, consisting of beta-blockers, angiotensin-converting-enzyme inhibitors (ACEis)/angiotensin-receptor blockers (ARBs) and mineralocorticoid receptor antagonists (MRAs), in patients with new-onset HF with and without AF.

methodsAmong 607 patients with new-onset HF (<3 months) from a specialized nurse-led HF clinic in the Netherlands, 187 (31%) patients had AF, and 420 (69%) patients were in sinus rhythm at baseline electrocardiogram. After an up-titration period of 9 months, achieved doses and reasons for not reaching target doses were documented.

resultsPatients with AF were older, less likely to have ischaemic heart disease and had higher baseline N-terminal B-type natriuretic peptide levels (all P < 0.05). Left ventricular ejection fraction (LVEF) at baseline was similar between patients with AF and those in sinus rhythm (37% vs. 36%, P = 0.453). Prescription of GDMT was comparable between patients with AF and those in sinus rhythm, except for a lower ACEi/ARB prescription and higher use of diuretics in patients with AF (79% vs. 86%; P = 0.038; 86% vs. 59%, P < 0.001, respectively, compared with sinus rhythm). Up-titration to guideline-recommended target doses of beta-blocker, ACEi/ARB and MRA therapy was similar between patients with and without AF (31% vs. 24%, P = 0.096; 32% vs. 40%, P = 0.098; 23.7% vs. 30.5%, P = 0.125, respectively). Reasons for not further up-titrating to recommended target doses were consistent across patients with AF and sinus rhythm. LVEF improvement of ≥5% and ≥10% after up-titration was more common in patients with AF than those in sinus rhythm (67% vs. 53%, P = 0.017; 48% vs. 36%, P = 0.043). Achieving target doses of ACEi/ARB and MRA therapies was associated with lower mortality and HF rehospitalization rates at 3 years in both patients with AF and those in sinus rhythm.

conclusionsIn patients with new-onset HF, up-titration to recommended doses of GDMT was similar in patients with and without AF, but was associated with a greater improvement in LVEF in patients with AF.

Indexed as

Adrenergic beta-AntagonistsAngiotensin-Converting Enzyme InhibitorsAngiotensin Receptor AntagonistsAtrial FibrillationHeart FailureStroke VolumeVentricular Function, LeftAgedDose-Response Relationship, DrugElectrocardiographyFemaleFollow-Up StudiesHumansMaleMiddle AgedMineralocorticoid Receptor AntagonistsAdrenergic beta-AntagonistsAngiotensin-Converting Enzyme InhibitorsAngiotensin Receptor AntagonistsMineralocorticoid Receptor Antagonistsatrial fibrillationguideline‐directed medical therapyheart failureleft ventricular ejection fractionup‐titration

Identifiers

PMID39968941
PMCPMC12055375

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.