Serelaxin in acute heart failure patients with and without atrial fibrillation: a secondary analysis of the RELAX-AHF trial.
BACKGROUND
Atrial fibrillation (AFib) is a common comorbidity in HF and affects patients' outcome. We sought to assess the effects of serelaxin in patients with and without AFib.


METHODS
In a post hoc analysis of the RELAX-AHF trial, we compared the effects of serelaxin on efficacy end points, safety end points and biomarkers in 1161 patients with and without AFib on admission electrocardiogram.


RESULTS
AFib was present in 41.3% of patients. Serelaxin had a similar effect in patients with and without AFib, including dyspnea relief by visual analog scale through day 5 [mean change in area under the curve, 541.11 (33.79, 1048.44), p = 0.0366 in AFib versus 361.80 (-63.30, 786.90), p = 0.0953 in non-AFib, interaction p = 0.5954] and all-cause death through day 180 [HR = 0.42 (0.23, 0.77), p = 0.0051 in AFib versus 0.90 (0.53, 1.52), p = 0.6888 in non-AFib, interaction p = 0.0643]. Serelaxin was similarly safe in the two groups and induced similar reductions in biomarkers of cardiac, renal and hepatic damage. Stroke occurred more frequently in AFib patients (2.8 vs. 0.8%, p = 0.0116) and there was a trend for lower stroke incidence in the serelaxin arm in AFib patients (odds ratios, 0.31, p = 0.0759 versus 3.88, p = 0.2255 in non-AFib, interaction p = 0.0518).


CONCLUSIONS
Serelaxin was similarly safe and efficacious in improving short- and long-term outcomes and inducing organ protection in acute HF patients with and without AFib.
National and Kapodistrian University of Athens, Medical School, Athens, Greece. geros@otenet.gr.|Heart Failure Unit, Department of Cardiology, Athens University Hospital Attikon, 1 Rimini St, 12462, Athens, Greece. geros@otenet.gr.
Gerasimos
G
Filippatos
National and Kapodistrian University of Athens, Medical School, Athens, Greece.
Dimitrios
D
Farmakis
University of Brescia, Brescia, Italy.
Marco
M
Metra
Momentum Research Inc., Durham, NC, USA.
Gad
G
Cotter
Momentum Research Inc., Durham, NC, USA.
Beth A
BA
Davison
Duke Clinical Research Institute, Durham, NC, USA.
G Michael
GM
Felker
University of California at San Diego, San Diego, CA, USA.
Barry H
BH
Greenberg
Novartis Pharmaceuticals Corporation, New Hanover, NJ, USA.
Tsushung A
TA
Hua
Indiana University School of Medicine and Regenstrief Institute, Indianapolis, IN, USA.
Peter S
PS
Pang
Clinical Military Hospital, Medical University, Wroclaw, Poland.
Piotr
P
Ponikowski
Columbia University, New York, NY, USA.
Min
M
Qian
Novartis Pharma AG, Basel, Switzerland.
Thomas A
TA
Severin
University of Groningen, Groningen, The Netherlands.
Adriaan A
AA
Voors
University of California-San Francisco and San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA.
John R
JR
Teerlink
D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy*; D015415:Biomarkers; D002317:Cardiovascular Agents / Q000009:adverse effects / Q000627:therapeutic use*; D004417:Dyspnea / Q000188:drug therapy / Q000209:etiology; D004562:Electrocardiography; D005260:Female; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011994:Recombinant Proteins / Q000009:adverse effects / Q000627:therapeutic use; D012065:Relaxin / Q000009:adverse effects / Q000627:therapeutic use*; D020521:Stroke / Q000453:epidemiology / Q000209:etiology; D016896:Treatment Outcome
D015415:Biomarkers; D002317:Cardiovascular Agents; D011994:Recombinant Proteins; C577649:serelaxin protein, human; D012065:Relaxin
Acute heart failure; Atrial fibrillation; Relaxin; Serelaxin