Maggioni AP et al. (2005) Valsartan reduces the incidence of atrial fibrillation in patients with heart failure: results from the Valsartan Heart Failure Trial (Val-HeFT). Am Heart J 149: 548–557

Atrial fibrillation (AF) occurrence is generally considered to worsen the prognosis of patients with heart failure (HF), and recurrence following AF treatment is very common. Cardiac remodeling is thought to be a major contributory factor. The Valsartan Heart Failure Trial (Val-HeFT) investigated the use of the angiotensin-receptor blocker valsartan in addition to normal therapy in patients with HF.

Maggioni et al. conducted a retrospective analysis of 4,395 Val-HeFT patients in sinus rhythm at baseline to investigate how development of AF affected HF outcomes, whether valsartan can prevent AF, and to identify independent predictors of AF. Patients had been randomized to receive either valsartan 40–160 mg twice daily (n = 2205) or placebo (n = 2190).

AF occurrence increased the risk of all-cause death by 40% and that of combined morbidity and mortality by 38%. Over a mean follow-up of 23 months, valsartan showed a significant relative risk reduction for AF development of 37% compared with placebo (absolute risk reduction 2.83%). In a multivariate analysis, increased brain natriuretic peptide level doubled the risk of AF, and age ≥70 years and male sex were strong predictors of AF.

This study provides further evidence that AF occurrence is a negative prognostic factor in patients with HF, although AF development was defined from only one baseline electrocardiogram. Valsartan in combination with normal HF therapy seems to lessen the risk of AF, but the authors suggest specifically designed, randomized clinical trials to confirm this.