Long-term outcomes of secondary atrial fibrillation in the community: the Framingham Heart Study
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Long-term outcomes of secondary atrial fibrillation in the community: the Framingham Heart Study. / Lubitz, Steven A; Yin, Xiaoyan; Rienstra, Michiel; Schnabel, Renate B; Walkey, Allan J; Magnani, Jared W; Rahman, Faisal; McManus, David D; Tadros, Thomas M; Levy, Daniel; Vasan, Ramachandran S; Larson, Martin G; Ellinor, Patrick T; Benjamin, Emelia J.
in: CIRCULATION, Jahrgang 131, Nr. 19, 12.05.2015, S. 1648-1655.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Long-term outcomes of secondary atrial fibrillation in the community: the Framingham Heart Study
AU - Lubitz, Steven A
AU - Yin, Xiaoyan
AU - Rienstra, Michiel
AU - Schnabel, Renate B
AU - Walkey, Allan J
AU - Magnani, Jared W
AU - Rahman, Faisal
AU - McManus, David D
AU - Tadros, Thomas M
AU - Levy, Daniel
AU - Vasan, Ramachandran S
AU - Larson, Martin G
AU - Ellinor, Patrick T
AU - Benjamin, Emelia J
N1 - © 2015 American Heart Association, Inc.
PY - 2015/5/12
Y1 - 2015/5/12
N2 - BACKGROUND: Guidelines have proposed that atrial fibrillation (AF) can occur as an isolated event, particularly when precipitated by a secondary, or reversible, condition. However, knowledge of long-term AF outcomes after diagnosis during a secondary precipitant is limited.METHODS AND RESULTS: In 1409 Framingham Heart Study participants with new-onset AF, we examined associations between first-detected AF episodes occurring with and without a secondary precipitant and both long-term AF recurrence and morbidity. We selected secondary precipitants based on guidelines (surgery, infection, acute myocardial infarction, thyrotoxicosis, acute alcohol consumption, acute pericardial disease, pulmonary embolism, or other acute pulmonary disease). Among 439 patients (31%) with AF diagnosed during a secondary precipitant, cardiothoracic surgery (n=131 [30%]), infection (n=102 [23%]), noncardiothoracic surgery (n=87 [20%]), and acute myocardial infarction (n=78 [18%]) were most common. AF recurred in 544 of 846 eligible individuals without permanent AF (5-, 10-, and 15-year recurrences of 42%, 56%, and 62% with versus 59%, 69%, and 71% without secondary precipitants; multivariable-adjusted hazard ratio, 0.65 [95% confidence interval, 0.54-0.78]). Stroke risk (n=209/1262 at risk; hazard ratio, 1.13 [95% confidence interval, 0.82-1.57]) and mortality (n=1098/1409 at risk; hazard ratio, 1.00 [95% confidence interval, 0.87-1.15]) were similar between those with and without secondary precipitants, although heart failure risk was reduced (n=294/1107 at risk; hazard ratio, 0.74 [95% confidence interval, 0.56-0.97]).CONCLUSIONS: AF recurs in most individuals, including those diagnosed with secondary precipitants. Long-term AF-related stroke and mortality risks were similar between individuals with and without secondary AF precipitants. Future studies may determine whether increased arrhythmia surveillance or adherence to general AF management principles in patients with reversible AF precipitants will reduce morbidity.
AB - BACKGROUND: Guidelines have proposed that atrial fibrillation (AF) can occur as an isolated event, particularly when precipitated by a secondary, or reversible, condition. However, knowledge of long-term AF outcomes after diagnosis during a secondary precipitant is limited.METHODS AND RESULTS: In 1409 Framingham Heart Study participants with new-onset AF, we examined associations between first-detected AF episodes occurring with and without a secondary precipitant and both long-term AF recurrence and morbidity. We selected secondary precipitants based on guidelines (surgery, infection, acute myocardial infarction, thyrotoxicosis, acute alcohol consumption, acute pericardial disease, pulmonary embolism, or other acute pulmonary disease). Among 439 patients (31%) with AF diagnosed during a secondary precipitant, cardiothoracic surgery (n=131 [30%]), infection (n=102 [23%]), noncardiothoracic surgery (n=87 [20%]), and acute myocardial infarction (n=78 [18%]) were most common. AF recurred in 544 of 846 eligible individuals without permanent AF (5-, 10-, and 15-year recurrences of 42%, 56%, and 62% with versus 59%, 69%, and 71% without secondary precipitants; multivariable-adjusted hazard ratio, 0.65 [95% confidence interval, 0.54-0.78]). Stroke risk (n=209/1262 at risk; hazard ratio, 1.13 [95% confidence interval, 0.82-1.57]) and mortality (n=1098/1409 at risk; hazard ratio, 1.00 [95% confidence interval, 0.87-1.15]) were similar between those with and without secondary precipitants, although heart failure risk was reduced (n=294/1107 at risk; hazard ratio, 0.74 [95% confidence interval, 0.56-0.97]).CONCLUSIONS: AF recurs in most individuals, including those diagnosed with secondary precipitants. Long-term AF-related stroke and mortality risks were similar between individuals with and without secondary AF precipitants. Future studies may determine whether increased arrhythmia surveillance or adherence to general AF management principles in patients with reversible AF precipitants will reduce morbidity.
KW - Aged
KW - Aged, 80 and over
KW - Alcoholic Intoxication/complications
KW - Atrial Fibrillation/drug therapy
KW - Female
KW - Heart Diseases/complications
KW - Heart Failure/epidemiology
KW - Humans
KW - Infections/complications
KW - Male
KW - Middle Aged
KW - Postoperative Complications/epidemiology
KW - Practice Guidelines as Topic
KW - Prognosis
KW - Pulmonary Embolism/complications
KW - Recurrence
KW - Stroke/epidemiology
KW - Survival Analysis
KW - Thyrotoxicosis/complications
KW - Treatment Outcome
U2 - 10.1161/CIRCULATIONAHA.114.014058
DO - 10.1161/CIRCULATIONAHA.114.014058
M3 - SCORING: Journal article
C2 - 25769640
VL - 131
SP - 1648
EP - 1655
JO - CIRCULATION
JF - CIRCULATION
SN - 0009-7322
IS - 19
ER -
