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The association between patterns of atrial fibrillation, anticoagulation, and cardiovascular events.

Atar, D; Berge, E; Le Heuzey, J-Y; Virdone, S; Camm, AJ; Steffel, J; Gibbs, H; Goldhaber, SZ; Goto, S; Kayani, G; et al. Atar, D; Berge, E; Le Heuzey, J-Y; Virdone, S; Camm, AJ; Steffel, J; Gibbs, H; Goldhaber, SZ; Goto, S; Kayani, G; Misselwitz, F; Stepinska, J; Turpie, AGG; Bassand, J-P; Kakkar, AK (2020) The association between patterns of atrial fibrillation, anticoagulation, and cardiovascular events. Europace, 22 (2). pp. 195-204. ISSN 1532-2092 https://doi.org/10.1093/europace/euz292
SGUL Authors: Camm, Alan John

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Abstract

AIMS: Guidelines do not recommend to take pattern of atrial fibrillation (AF) into account for the indication of anticoagulation (AC). We assessed AF pattern and the risk of cardiovascular events during 2-years of follow-up. METHODS AND RESULTS: We categorized AF as paroxysmal, persistent, or permanent in 29 181 patients enrolled (2010-15) in the Global Anticoagulant Registry In the FIELD of AF (GARFIELD-AF). We used multivariable Cox regression to assess the risks of stroke/systemic embolism (SE) and death across patterns of AF, and whether this changed with AC on outcomes. Atrial fibrillation pattern was paroxysmal in 14 344 (49.2%), persistent in 8064 (27.6%), and permanent 6773 (23.2%) patients. Median CHA2DS2-VASc, GARFIELD-AF, and HAS-BLED scores assessing the risk of stroke/SE and/or bleeding were similar across AF patterns, but the risk of death, as assessed by the GARFIELD-AF risk calculator, was higher in non-paroxysmal than in paroxysmal AF patterns. During 2-year follow-up, after adjustment, non-paroxysmal AF patterns were associated with significantly higher rates of all-cause death, stroke/SE, and new/worsening congestive heart failure (CHF) than paroxysmal AF in non-anticoagulated patients only. In anticoagulated patients, a significantly higher risk of death but not of stroke/SE and new/worsening CHF persisted in non-paroxysmal compared with paroxysmal AF patterns. CONCLUSION: In non-anticoagulated patients, non-paroxysmal AF patterns were associated with higher risks of stroke/SE, new/worsening HF and death than paroxysmal AF. In anticoagulated patients, the risk of stroke/SE and new/worsening HF was similar across all AF patterns. Thus AF pattern is no longer prognostic for stroke/SE when patients are treated with anticoagulants. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362.

Item Type: Article
Additional Information: © The Author(s) 2019. Published by Oxford University Press on behalf of the European Society of Cardiology This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
Keywords: Anticoagulation, Atrial fibrillation, Atrial fibrillation type, Cardiovascular outcome, Registry, Stroke prevention, 1103 Clinical Sciences, Cardiovascular System & Hematology
SGUL Research Institute / Research Centre: Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Journal or Publication Title: Europace
ISSN: 1532-2092
Language: eng
Dates:
DateEvent
February 2020Published
20 November 2019Published Online
7 October 2019Accepted
Publisher License: Creative Commons: Attribution-Noncommercial 4.0
PubMed ID: 31747004
Go to PubMed abstract
URI: http://openaccess.sgul.ac.uk/id/eprint/111442
Publisher's version: https://doi.org/10.1093/europace/euz292

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