Use of cardiovascular drugs and risk of incident heart failure in patients with atrial fibrillation

Per Wändell, Axel C. Carlsson, Xinjun Li, Martin J. Holzmann, Jan Sundquist, Kristina Sundquist

Research output: Contribution to journalArticlepeer-review


Congestive heart failure (CHF) is the most important cause of death in patients with atrial fibrillation (AF). We aimed to study the association between cardiovascular drugs in AF patients and incident CHF. The study population included all adults (n = 120 756) aged ≥45 years diagnosed with AF in Sweden diagnosed for the period 1998-2006. Outcome was incident congestive heart failure (follow-up 2007-2015) in AF patients. Associations between treatment with cardiovascular pharmacotherapies and CHF were evaluated using Cox regression to estimate hazard ratios (HRs) with 95% CIs, after adjustment for age, sociodemographic variables, and comorbidities. During a mean 5.3 years (SD 3.0) of follow-up, there were 28 257 (23.4%) incident cases of CHF. Treatment with beta-1-selective and non-selective beta-blockers and statins was associated with lower risks of incident CHF in men, HR, (95% CI); 0.90, (0.87-0.94); 0.90, (0.84-0.97), and 0.94, (0.90-0.99), respectively. Only beta-1-selective beta-blockers were protective in women 0.94 (0.91-0.98). Treatment with loop diuretics, potassium-saving agents, ACE inhibitors, and angiotensin receptor blockers was associated with a higher risk of CHF. For men, treatment with heart-active calcium channel blockers also led to a higher risk of CHF. In conclusion, we found that beta-blockers, in particular, but also statins were associated with lower risk of incident CHF in patients with AF.

Original languageEnglish
Pages (from-to)1396-1405
Number of pages10
JournalJournal of Clinical Hypertension
Issue number8
StatePublished - 1 Aug 2020


  • atrial fibrillation
  • congestive heart failure
  • drug treatment
  • gender


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