Risk of cardiovascular and cerebrovascular events after atrial fibrillation diagnosis☆
Introduction
Atrial fibrillation (AF) is the most common cardiac arrhythmia, affecting approximately 1% of the total adult population [1] increasing to 9% in individuals over 80 years old [2]. Diabetes, hypertension, congestive heart failure and valve disease, among others, are independent risk factors for AF [3]. Several studies have previously reported an adverse prognosis of AF patients in terms of stroke, congestive heart failure and mortality [4], [5], [6]. Mortality from AF is especially high in the first four months after diagnosis [7], but AF is also associated with a long-term elevation in mortality, with the death rate among patients newly diagnosed with chronic AF being almost three times that in the general population during four years of follow-up [8]. The major cause of excess mortality among patients with chronic AF is non-ischemic heart disease, with ischemic cardiovascular and cerebrovascular disease also making a contribution. Thus, while the main burden known to be associated with AF is an increased risk of ischemic cerebrovascular events (ICVE) [4], [8], AF is also common in patients with severe chronic heart failure (HF) [2], [4], although this association is not as well characterized [9]. The association of AF with other subsequent arterial thrombotic disorders such as coronary events (CE) remains unclear.
The aims of the present study were to assess the incidence of further cardiovascular events (ICVE, CE and HF) in patients with a first diagnosis of AF and free of ICVE, CE or HF at baseline, and to evaluate the role of traditional risk factors for ICVE, CE and HF in AF patients.
Section snippets
Data source
The UK General Practice Research Database (GPRD) contains computerized information entered by primary care physicians in the UK. The vast majority of the UK population is registered with a primary care physician. At the time of the study, around 1500 physicians were participating in the GPRD, covering a population of around 3 million individuals broadly representative of the UK population. The primary care physicians hold the complete medical record of registered individuals, including
Results
The AF and comparison groups consisted of 831 and 8226 patients, respectively. The characteristics of both study groups at the start of follow-up are shown in Table 1. Patients were followed for a maximum of 6 years (mean 3.6 ± 1.5 years). During this period, 261 patients in the AF group and 622 in the control group had a first diagnosis of a cardiovascular event, equating to an incidence of 11.1 per 100 patient-years (95% confidence interval [CI]: 9.9–12.5) in the AF group and 2.1 per 100
Discussion
This study found that a first diagnosis of AF significantly increased the subsequent risk of new cardiovascular events compared with patients without AF. This risk was particularly increased in older patients and those with diabetes or other cardiovascular diseases as indicated above, and was greater in patients with CAF than those with PAF. A worse prognosis among patients with CAF has been seen in previous studies. For example, in a study of 145 patients with lone AF, 30.6% of patients with
Acknowledgements
We would like to thank Dr Hector Bueno of Gregorio Marañon University Hospital, Madrid, Spain for his helpful suggestions to prior versions of the manuscript. We also thank Dr Christopher Winchester of Oxford PharmaGenesis Ltd for his editorial assistance. This study was supported by a research grant from AstraZeneca and was presented at the World Congress of Cardiology 2006.
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Rationale, considerations, and goals for atrial fibrillation centers of excellence: A Heart Rhythm Society perspective
2020, Heart RhythmCitation Excerpt :By establishing programs focused on minimizing these disparities, we believe there is an important opportunity to improve the quality and equality of care and thereby improve outcomes for patients with AF. The existing uncoordinated manner in which AF risk factors (eg, hypertension, diabetes, obesity, sleep apnea, etc) and comorbidities are treated results in greater AF progression and untoward cardiovascular outcomes.50,51 Randomized trials utilizing a multidisciplinary, integrated AF clinic approach to AF management, with a focus on risk factor management, have resulted in reductions in wait times for specialist assessment, emergency department visits, hospitalizations, and mortality.52
Atrial fibrillation and ischemic heart disease: beyond stroke prevention
2020, Revista Espanola de Cardiologia SuplementosSex differences in stroke and major adverse clinical events in patients with atrial fibrillation: A systematic review and meta-analysis of 993,600 patients
2018, International Journal of CardiologyCitation Excerpt :Data on 993,603 AF patients were retrieved from the 44 studies, with 485,933 (48.9%) women and 507,670 (51.1%) men. Twenty-six studies [12, 14–17, 19–21, 23, 24, 26, 28, 29, 31–33, 35, 37, 38, 40, 44, 45, 47, 49, 52, 55] reported data on stroke occurrence, 22 studies [13, 18, 19, 22, 23, 25, 27, 30, 31, 34, 36, 37, 39, 41–43, 46, 48, 50, 51, 53, 54] reported data on TE occurrence, 16 studies [15, 36, 39, 43, 46–53] reported data on major bleeding, 7 studies [19, 27, 35, 36, 39, 45, 46] reported data on CV death and, lastly, 13 studies [19, 23, 25, 33, 35, 36, 38, 39, 43, 45, 47, 50, 52] reported data on all-cause death. Pooling of studies results showed that female AF patients were at higher risk of stroke compared to male AF patients, with a 24% of relative risk increase (HR: 1.24; 95% CI: 1.14–1.36; p < 0.001) with a moderate heterogeneity (I2 = 55.96%) [Fig. 1].
Gender differences of thromboembolic events in atrial fibrillation
2016, American Journal of CardiologyCitation Excerpt :We compiled over 30 studies published since 1999 that examine gender and thromboembolic risk, including 5 randomized controlled trials (RCTs) and 24 observational studies (Tables 1 and 2). Of these 30 studies, 17 studies reported that female gender is a significant risk factor,13–16,19,21,22,25,27,31,33–39 12 studies reported that female gender is not significant,17,18,20,23,24,26,28–30,32,40,41 and only 1 study reported that male gender is a significant risk factor.12 Four additional RCTs compared novel oral anticoagulant drugs (NOAC) and warfarin, providing further data on gender differences (Table 3).42–45
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Disclosures: this study was funded by a research grant from AstraZeneca R&D Mölndal, Sweden. Dr Wallander, Dr Johansson and Dr Edvardsson are employees of AstraZeneca. Dr Ruigómez and Dr García Rodríguez work for CEIFE, which has received research grants from AstraZeneca. The corresponding author had full access to all the data in the study, and takes responsibility for the integrity of the data and the accuracy of the data analysis.