Bidirectional association between aortic dissection and atrial fibrillation: Findings from a huge national database

Abstract

Objective To explore the link between aortic dissection (AD) and atrial fibrillation (AF). Methods Using the National Health Insurance Research Database (NHIRD), cohorts were constructed for evaluating the incidence of AF in patients with AD (study 1) and the incident AD among AF patients (study 2) based on propensity matching analysis. Cox proportion hazard regression models were used to examine the effect of AD on the risk of AF, shown as hazard ratios (HRs) with 95% confidence intervals (CIs). Similar statistical procedures were used for study 2. Results The study 1 consisted of 11 813 patients in the AD cohort and 11 813 controls in the non‐AD cohort and the study 2 consisted of 190 494 patients in the AF cohort and 190 494 controls in the non‐AF cohort. The overall incidence density of AF was 1.32‐fold higher in the AD cohort than in the non‐AD cohort (11.1 and 8.3 per 1000 person‐years), with an adjusted HR (aHR) of 1.74 (95% CI = 1.53‐1.98). The AF cohort had 1.18‐fold higher incidence of AD than the non‐AF cohort (0.55 vs 0.47 per 1000 person‐years), with an aHR of 1.24 (95% CI = 1.07‐1.44). Conclusions Bidirectional association between AD and AF was shown for the first time in this study.

Prognostic impact of oral anticoagulation therapy and atrial fibrillation in patients with type B acute aortic dissection

“…The incidence of AF in AAD patients is reported to be approximately 12%-17%. [1][2][3] In this study, AF was observed in 27/139 patients (19%), similar to the findings of previous studies. A study based on a Taiwanese national database reported that patients with AF had a 1.18-fold higher incidence of AAD than those without AF.…”

“…Acute aortic dissection (AAD) is often complicated by atrial fibrillation (AF), with an incidence of 12%-17%. [1][2][3] These conditions share common risk factors, including atherosclerosis, hypertension, sleep apnea, and advanced age. [4][5][6][7][8][9][10] However, research on whether the presence of AF contributes to a worse prognosis in patients with AAD is lacking.…”

“…Acute aortic dissection (AAD) is often complicated by atrial fibrillation (AF), with an incidence of 12%–17% 1–3 . These conditions share common risk factors, including atherosclerosis, hypertension, sleep apnea, and advanced age 4–10 .…”

Anticoagulant and anti-thrombotic therapy in acute type B aortic dissection: when real-life scenarios face the shadows of the evidence-based medicine

“…Von Kodolitsch et al showed that anticoagulation with warfarin is feasible even in post-surgical patients with type A aortic dissection as it did not affect aortic growth and was not associated with late mortality nor with late aortic events, thus suggesting that patients requiring anticoagulation due to other indications should be indeed considered on individualized basis to receive such treatment [16]. This holds true especially for atrial fibrillation, which is not uncommon among patients with aortic dissection [17]; few reports have addressed the issue of anticoagulation in this scenario with heterogeneous results and patient-tailored therapy seems the best treatment option until larger studies will focus on this topic [18,19].…”

Sex Differences in Temporal Trends and Risk Factors of Aortic Dissection in Taiwan

“… 23 Our analysis showed that chronic kidney disease was associated with 3.2‐fold increased odds of AD occurrence in women and 2.4‐fold increased odds of occurrence in men. Similarly, there have been few studies linking atrial fibrillation to AD, 24 although evidence has shown a high prevalence of atrial fibrillation in patients with AD (16.1% in men and 14.3% in women in the OxVasc [Oxford Vascular Study]). 2 We found that the elevated odds of AD occurrence associated with atrial fibrillation were 58% stronger in women than in men.…”