Real-Life Incident Atrial Fibrillation in Outpatients with Coronary Artery Disease

Abstract

Background: The risk, correlates, and consequences of incident atrial fibrillation (AF) in patients with chronic coronary artery disease (CAD) are largely unknown. Methods and results: We analyzed incident AF during a 3-year follow-up in 5031 CAD outpatients included in the prospective multicenter CARDIONOR registry and with no history of AF at baseline. Incident AF occurred in 266 patients (3-year cumulative incidence: 4.7% (95% confidence interval (CI): 4.1 to 5.3)). Incident AF was diagnosed during cardiology outpatient visits in 177 (66.5%) patients, 87 of whom were asymptomatic. Of note, 46 (17.3%) patients were diagnosed at time of hospitalization for heart failure, and a few patients (n = 5) at the time of ischemic stroke. Five variables were independently associated with incident AF: older age (p < 0.0001), heart failure (p = 0.003), lower left ventricle ejection fraction (p = 0.008), history of hypertension (p = 0.010), and diabetes mellitus (p = 0.033). Anticoagulant therapy was used in 245 (92%) patients and was associated with an antiplatelet drug in half (n = 122). Incident AF was a powerful predictor of all-cause (adjusted hazard ratio: 2.04; 95% CI: 1.47 to 2.83; p < 0.0001) and cardiovascular mortality (adjusted hazard ratio: 2.88; 95% CI: 1.88 to 4.43; p < 0.0001). Conclusions: In CAD outpatients, real-life incident AF occurs at a stable rate of 1.6% annually and is frequently diagnosed in asymptomatic patients during cardiology outpatient visits. Anticoagulation is used in most cases, often combined with antiplatelet therapy. Incident AF is associated with increased mortality.

Predicting Silent Atrial Fibrillation in the Elderly: A Report from the NOMED-AF Cross-Sectional Study

“…The risk factors for AF are well established and include hypertension, heart failure (HF), physical activity, obesity, chronic coronary syndromes, chronic kidney disease (CKD), and hyperthyroidism [ 1 , 2 , 3 , 4 ]. The determination of risk factors is particularly important in patients with silent atrial fibrillation (SAF), but their identification is a challenge in everyday clinical practice and, often, such patients are diagnosed for the first time when they present with an AF-related complication, such as stroke or heart failure; however, general population-based data for silent AF (SAF) are limited.…”

Cardiovascular and renal multimorbidity increase risk of atrial fibrillation in the PREVEND cohort

“…This is also reflected in research; studies would look at the association of individual risk factors and comorbidities with incident AF. [2][3][4][5][6] However, individuals with AF commonly have more than one comorbidity and thus multimorbidity. 1 16-18 This study has shown that latent class analysis can be used to define clusters of comorbidities, but that the clusters seem to be based on the amount of comorbidities, rather than specific combinations of comorbidities.…”

“…1 Presence of specific cardiovascular risk factors and/ or comorbidities increase the risk of incident AF. [2][3][4][5][6] Both the prevalence of AF and of comorbidities increase with age, causing the prevalence of multimorbidity (the presence of two or more comorbidities in an individual) to increase as well. [7][8][9][10][11] With the accumulation of comorbidities over time, certain comorbidities may more often occur together than others, that is, clustering of comorbidities.…”

New Perspective in Atrial Fibrillation

“…A better understanding of AF pathophysiology could come from the integration of all the cardiac environment modulators, including "Coumel triangle" components [3]. Indeed, apart from the pulmonary vein triggers that have been extensively studied [4], the relationship between other triggers (inflammation as in acute AF [5][6][7], stable coronary artery disease [8], or post-operative AF [9]), the modulator (mainly autonomic nervous system dysregulation [10]) and substrate alterations (fibrosis but also changes in the conduction properties of the atrial cells even in the absence of a quantifiable "scar" [11]) have been recently brought to light by several papers [12,13]. The interplay between cardiovascular risk factors, mainly high blood pressure [14] and obesity [6], atrial epicardial fat, and atrial ganglionated plexi [15], is complex and critical for the understanding of AF, but also in the search for new treatments.…”