Mid-Term Prognosis After Landiolol Treatment in Atrial Fibrillation/Atrial Flutter Patients With Chronic Heart Failure ― A Prospective Observational Survey (AF-CHF Landiolol Survey) ―

Background: The aim of the prospective post-marketing AF-CHF Landiolol Survey was to evaluate the safety and effectiveness of landiolol for the treatment of atrial fibrillation or atrial flutter in patients with cardiac dysfunction in clinical practice in Japan. This analysis reports mid-term prognoses with a focus on switching from landiolol to oral β-blockers. Methods and Results: The AF-CHF Landiolol Survey took place between June 2014 and May 2016 and involved 1,121 patients with cardiac dysfunction and atrial fibrillation/atrial flutter. Data collected about switching from landiolol to oral β-blockers were analyzed in relation to all-cause mortality within 180 days after landiolol initiation. Among 1,002 patients with available follow-up data, the 6-month all-cause mortality rate was 14. 6% (n=146 patients), of whom 39.7% had died from heart failure (HF). Kaplan-Meier survival curves showed significantly longer survival in patients who had switched to oral β-blockers vs. those who had not, with hazard ratios of 0.39 (95% confidence interval [CI] 0.28-0.55) for all-cause mortality and 0.40 (95% CI: 0.23-0.70) for death from HF. Only male sex and advanced age were independently associated with all-cause mortality and death from HF. Conclusions: This large-scale routine practice survey of landiolol in HF patients with atrial fibrillation/flutter showed high mid-term all-cause mortality. Switching from landiolol to oral β-blockers was apparently, although not independently, associated with lower all-cause mortality and death from HF.