Prevalence, Characteristics, and Outcomes of Valvular Heart Disease in Patients With Atrial Fibrillation: Insights From the ORBIT‐AF (Outcomes Registry for Better Informed Treatment for Atrial Fibrillation)

Abstract

BackgroundThe presence of valvular heart disease (VHD) may affect the risk of stroke and mortality in patients with atrial fibrillation (AF). Community‐based estimates of prevalence and outcomes of specific forms of VHD in patients with AF are lacking.Methods and ResultsWe examined the prevalence of VHD, anticoagulation use, mortality, stroke/transient ischemic attack, and bleeding among a community cohort of patients with AF. Significant VHD was defined as follows: (1) moderate/severe mitral stenosis or mechanical valve; (2) bioprosthetic valve, surgical repair, or balloon valvuloplasty; and (3) moderate/severe aortic regurgitation or stenosis, mitral regurgitation, or tricuspid regurgitation. Proportional hazards models were performed to test the association between VHD groups and outcomes. Among 9748 patients with AF, 2705 (27.7%) had significant VHD. Anticoagulation use was highest among patients with mitral stenosis/mechanical valve (91.8%). Compared with individuals with no significant VHD, individuals with aortic regurgitation/aortic stenosis, mitral regurgitation, or tricuspid regurgitation (hazard ratio, 1.23; 95% confidence interval, 1.07–1.42) had the highest risk of death. There were no differences in stroke or transient ischemic attack and major bleeding among individuals with and without significant VHD. Patients with AF and aortic stenosis had the highest risk of death (hazard ratio, 1.32; 95% confidence interval, 1.08–1.62).ConclusionsSignificant VHD is common among patients with AF in community practice. In a community cohort of patients with AF and CHA 2 DS 2‐VASc score ≥2, most were anticoagulated. Individuals with AF and moderate‐to‐severe biological VHD have more comorbidities and a higher mortality risk; however, stroke and major bleeding are similar among those with and without significant VHD.

Impact of Valvular Heart Disease on Mortality, Thromboembolic and Cardiac Events in Japanese Patients With Atrial Fibrillation ― The Fushimi AF Registry ―

“…The ORBIT-AF investigators demonstrated that MS, MR, AS, AR, and TR were not independent risk factors for stroke/ SE, and that only AS was associated with all-cause death. 20 Our current results were overall consistent with those of ORBIT-AF, and further confirmed that AS and AR are independent risk factors for hospitalization for HF, highlighting the importance of aortic valve diseases in adverse cardiac outcomes in AF patients.…”

“…The ORBIT-AF (Outcomes Registry for Better Informed Treatment for Atrial Fibrillation) investigators previously published the prevalence, clinical characteristics, and outcomes of VHD in AF patients in the USA. 20 In the ORBIT-AF, 2,705 patients (27.7%) had a history of significant VHD (moderate-to-severe VHD or prior valve surgery) and 403 patients (4.1%) had moderate-to-severe MS or a mechanical valve. The risk of stroke/SE/transient ischemic attack (TIA) in patients with AS/AR, MR, or TR (i.e., NVAF with VHD) was significantly higher than in those with no or mild VHD (unadjusted HR 1.53, 95% CI 1.20-1.96), whereas that of patients with MS or a mechanical valve (i.e., VAF) was not significantly higher (unadjusted HR 1.39, 95% CI 0.86-2.26) by univariate analyses.…”

Characteristics and 12-month outcome of patients with atrial fibrillation at a tertiary hospital in Botswana

“…Consistent with previous reports from SSA, our cohort was younger (67 years) than patients in developed countries, where most cases are recorded around the eighth decade of life. 7,[23][24][25][26] The mean age of African patients with AF has, on average, been a decade younger than patients in developed countries. 24,25 A shorter life expectancy in SSA and differences in the epidemiology of diseases associated with AF in developed and developing countries partly explain this age difference.…”

Ten-year trends in the incidence, treatment and outcomes of patients with mitral stenosis in Korea

“…Mitral stenosis remains a major cause of morbidity and mortality, primarily due to the accompanying AF. Mitral stenosis combined with AF is common, and over 20% of patients experience worse outcomes associated with systemic embolism 12. Atrial contraction ensures blood flow across the left atrium to ventricle.…”