Long-term risk of adverse outcomes according to atrial fibrillation type

• Published in: Scientific reports Vol. 12; no. 1; p. 2208
• Main Authors: Blum, Steffen, Aeschbacher, Stefanie, Coslovsky, Michael, Meyre, Pascal B., Reddiess, Philipp, Ammann, Peter, Erne, Paul, Moschovitis, Giorgio, Di Valentino, Marcello, Shah, Dipen, Schläpfer, Jürg, Müller, Rahel, Beer, Jürg H., Kobza, Richard, Bonati, Leo H., Moutzouri, Elisavet, Rodondi, Nicolas, Meyer-Zürn, Christine, Kühne, Michael, Sticherling, Christian, Osswald, Stefan, Conen, David
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 09-02-2022; Nature Publishing Group; Nature Portfolio
• Subjects: 692/4019; 692/4019/592/75/29/1309; Aged; Aged, 80 and over; Atrial Fibrillation - complications; Atrial Fibrillation - epidemiology; Atrial Fibrillation - mortality; Bleeding; Cardiac arrhythmia; Cause of Death; Cerebral infarction; Cohort Studies; Comorbidity; Congestive heart failure; Embolism; Embolism - complications; Embolism - epidemiology; Female; Fibrillation; Follow-Up Studies; Heart attacks; Heart Failure - complications; Heart Failure - epidemiology; Hemorrhage - complications; Hemorrhage - epidemiology; Hospitalization - statistics & numerical data; Humanities and Social Sciences; Humans; Incidence; Male; Middle Aged; Mortality; multidisciplinary; Myocardial infarction; Myocardial Infarction - complications; Myocardial Infarction - epidemiology; Patients; Proportional Hazards Models; Prospective Studies; Risk Factors; Science; Science (multidisciplinary); Stroke; Stroke - complications; Stroke - epidemiology; Switzerland - epidemiology; Switzerland
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-022-05688-9

Sustained forms of atrial fibrillation (AF) may be associated with a higher risk of adverse outcomes, but few if any long-term studies took into account changes of AF type and co-morbidities over time. We prospectively followed 3843 AF patients and collected information on AF type and co-morbidities during yearly follow-ups. The primary outcome was a composite of stroke or systemic embolism (SE). Secondary outcomes included myocardial infarction, hospitalization for congestive heart failure (CHF), bleeding and all-cause mortality. Multivariable adjusted Cox proportional hazards models with time-varying covariates were used to compare hazard ratios (HR) according to AF type. At baseline 1895 (49%), 1046 (27%) and 902 (24%) patients had paroxysmal, persistent and permanent AF and 3234 (84%) were anticoagulated. After a median (IQR) follow-up of 3.0 (1.9; 4.2) years, the incidence of stroke/SE was 1.0 per 100 patient-years. The incidence of myocardial infarction, CHF, bleeding and all-cause mortality was 0.7, 3.0, 2.9 and 2.7 per 100 patient-years, respectively. The multivariable adjusted (a) HRs (95% confidence interval) for stroke/SE were 1.13 (0.69; 1.85) and 1.27 (0.83; 1.95) for time-updated persistent and permanent AF, respectively. The corresponding aHRs were 1.23 (0.89, 1.69) and 1.45 (1.12; 1.87) for all-cause mortality, 1.34 (1.00; 1.80) and 1.30 (1.01; 1.67) for CHF, 0.91 (0.48; 1.72) and 0.95 (0.56; 1.59) for myocardial infarction, and 0.89 (0.70; 1.14) and 1.00 (0.81; 1.24) for bleeding. In this large prospective cohort of AF patients, time-updated AF type was not associated with incident stroke/SE.