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

2022; Nature Portfolio; Volume: 12; Issue: 1 Linguagem: Inglês

10.1038/s41598-022-05688-9

2045-2322

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, 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, Mark G. Filipovic, Marcel Frick, Giulia Montrasio, S. Leuenberger, Franziska Rutz, Jürg H. Beer, Angelo Auricchio, Adriana Anesini, Cristina Camporini, Giulio Conte, Maria Luce Caputo, François Regoli, Tiziano Moccetti, Roman Brenner, David Altmann, Michaela Gemperle, Peter Ammann, Mathieu Firmann, Sandrine Foucras, Martine Rime, Daniel Hayoz, Benjamin Berte, Virgina Justi, Frauke Kellner‐Weldon, Brigitta Mehmann, Sonja Meier, Myriam Roth, Andrea Ruckli-Kaeppeli, Ian Russi, Kai Schmidt, Mabelle Young, Melanie Zbinden, Richard Kobza, Elia Rigamonti, Carlo W. Cereda, Alessandro Cianfoni, Maria Luisa De Perna, Jane Frangi-Kultalahti, Patrizia Assunta Mayer Melchiorre, Anica Pin, Tatiana Terrot, Luisa Vicari, Giorgio Moschovitis, Georg Ehret, Hervé Gallet, Elise Guillermet, François Lazeyras, Karl‐Olof Lövblad, Patrick Perret, Philippe Tavel, Cheryl Terés, Dipen Shah, Nathalie Lauriers, Marie Méan, Sandrine Salzmann, Jürg Schläpfer, Alessandra Pia Porretta, Andrea Grêt, Ján Novák, Sandra Vitelli, Frank‐Peter Stephan, Jane Frangi-Kultalahti, Augusto Gallino, Luisa Vicari, Marcello Di Valentino, Helena Aebersold, Fabienne Foster, Matthias Schwenkglenks, Jens Würfel, Anna Altermatt, Michael Amann, Marco Düring, P Huber, Esther Ruberte, Tim Sinnecker, Vanessa Zuber, Michael Coslovsky, Pascal Benkert, Gilles Dutilh, Milica Marković, Pia Neuschwander, Patrick Simon, Ramun Schmid,

Cardiac Imaging and Diagnostics

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.