Long-term risk of adverse outcomes according to atrial fibrillation type
Steffen Blum, Stefanie Aeschbacher, Michael Coslovsky, Pascal Meyre, Philipp Reddiess, Peter Ammann, Paul Erné, Giorgio Moschovitis, Marcello Di Valentino, Dipen Shah, Jürg Schläpfer, Rahel Müller, Jürg H. Beer, Richard Kobza, Leo H. Bonati, Elisavet Moutzouri, Nicolas Rodondi, Christine Meyer‐Zürn, Michael Kühne, Christian Sticherling, Stefan Osswald, David Conen, the BEAT-AF and Swiss-AF investigators, Stefanie Aeschbacher, Chloé Auberson, Steffen Blum, Leo H. Bonati, Selinda Ceylan, David Conen, Simone Evers-Doerpfeld, Ceylan Eken, Marc Girod, Elisa Hennings, Elena Herber, Vasco Iten, Philipp Krisai, Maurin Lampart, Mirko Lischer, Christine Meyer‐Zürn, Pascal Meyre, Andreas U. Monsch, Christian Müller, Rebecca E. Paladini, Anne Springer, Christian Sticherling, Thomas D. Szucs, Gian Völlmin, Stefan Osswald, Michael Kühne, Drahomir Aujesky, Urs Fischer, Juerg Fuhrer, Laurent Roten, Simon Jung, Heinrich P. Mattle, Seraina Netzer, Luise Adam, Carole E. Aubert, Martin Feller, Axel Loewe, Elisavet Moutzouri, Claudio Schneider, Tanja Flückiger, Cindy Groen, Lukas Ehrsam, Sven Hellrigl, Alexandra Nuoffer, Damiana Rakovic, Nathalie Schwab, Rylana Wenger, Tu Hanh Zarrabi Saffari, Nicolas Rodondi, Tobias Reichlin, Christopher Beynon, Roger Dillier, Michèle Deubelbeiss, Franz R. Eberli, C Franzini, Isabel Juchli, Claudia Liedtke, Samira Murugiah, Jacqueline Nadler, Thayze Obst, Jasmin Roth, Fiona Schlomowitsch, Xiaoye Schneider, Katrin Studerus, Noreen Tynan, Dominik Weishaupt, Andreas Müller, Simone Fontana, Corinne Friedli, Silke Küest, Karin Scheuch, Denise Hischier, Nicole R. Bonetti, Alexandra Grau, Jonas Villinger, Eva Laube, Philipp Baumgartner
Abstract
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.