Atrial fibrillation (AF) and
heart failure (HF) often coexist. The aims of this study were to explore the factors associated with the serum levels of N-terminal pro-
brain natriuretic peptide (
NT-proBNP), and the association between prognosis and a history of HF or the serum
NT-proBNP level in Japanese patients with AF.The present sub-study was based on the SAKURA AF Registry, a Japanese multicenter observational registry that included 3267 AF patients (median follow-up period: 39 months). All the patients were receiving
warfarin or any of four direct oral
anticoagulants. Serum
NT-proBNP levels were available for 2417 patients, and the median value was 508 (interquartile range 202-1095) pg/mL at the time of enrollment. Log
NT-proBNP was associated with non-paroxysmal AF,
creatinine clearance > 60 mL/minute, history of HF and
ischemic heart disease,
antiarrhythmic drug use,
anemia, being elderly female, and history of AF ablation. The relative risk of adverse clinical events, except major
bleeding, was significantly higher in the highest
NT-proBNP quartile as compared to the lowest quartile (adjusted hazard ratios: 2.87 for death, 2.39 for
stroke), but a history of HF was associated only with a higher incidence of all-cause death.Concomitant HF was associated with a higher mortality, but the high
NT-proBNP was associated with higher mortality and
stroke events. In Japanese AF patients receiving
anticoagulant treatment, high serum
NT-proBNP levels predict the risk for both
stroke events and deaths, and intensive follow-up is needed in such patients.