Optimal rate control in dogs with atrial fibrillation-ORCA study-Multicenter prospective observational study: Prognostic impact and predictors of rate control.
J Vet Intern Med
; 37(3): 887-899, 2023.
Article
em En
| MEDLINE
| ID: mdl-37128174
ABSTRACT
BACKGROUND:
The optimal heart rate (HR) in dogs with atrial fibrillation (AF) is unknown. Impact of HR on survival needs elucidation. HYPOTHESIS/OBJECTIVES:
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. ANIMALS Sixty dogs with AF.METHODS:
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.RESULTS:
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. CONCLUSIONS AND CLINICAL IMPORTANCE 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.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Fibrilação Atrial
/
Doenças do Cão
/
Insuficiência Cardíaca
Tipo de estudo:
Clinical_trials
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Animals
Idioma:
En
Revista:
J Vet Intern Med
Assunto da revista:
MEDICINA INTERNA
/
MEDICINA VETERINARIA
Ano de publicação:
2023
Tipo de documento:
Article
País de afiliação:
Reino Unido