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(Circulation. 1997;96:2455-2461.)
© 1997 American Heart Association, Inc.
Articles |
Incidence of and Risk Factors for Atrial Fibrillation in Older Adults
From the Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services (B.M.P.) and Department of Biostatistics (R.A.K.), University of Washington, Seattle; Division of Epidemiology and Clinical Applications, National Heart, Lung, and Blood Institute, Bethesda, Md (T.A.M.); Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh (Pa) (L.H.K.); Department of Medicine, University of Vermont, Burlington (M.C.); Departments of Medicine and Epidemiology, The Johns Hopkins University, Baltimore, Md (L.P.F.); Department of Medicine, University of California at Davis (R.W.); and Department of Public Health Sciences, Bowman Gray School of Medicine (C.D.F., P.M.R.), Winston-Salem, NC.
Background This study aimed to describe the incidence of atrial fibrillation (AF) among older adults during 3 years of follow-up.
Methods and Results In this cohort study, 5201 adults 
65
years old were examined annually on four occasions between June 1989
and May 1993. At baseline, participants answered questionnaires and
underwent a detailed examination that included carotid ultrasound,
pulmonary function tests, ECG, and
echocardiography. Subjects with a pacemaker or AF
at baseline (n=357) were excluded. New cases of AF were identified from
three sources: (1) annual self-reports, (2) annual ECGs, and (3)
hospital discharge diagnoses. Cox proportional-hazards models were used
to assess baseline risk factors as predictors of incident AF. Among
4844 participants, 304 developed a first episode of AF during an
average follow-up of 3.28 years, for an incidence of 19.2 per 1000
person-years. The onset was strongly associated with age, male sex, and
the presence of clinical cardiovascular disease. For
men 65 to 74 and 75 to 84 years old, the incidences were 17.6 and 42.7,
respectively, and for women, 10.1 and 21.6 events per 1000
person-years. In stepwise models, the use of diuretics, a
history of valvular heart disease, coronary disease,
advancing age, higher levels of systolic blood pressure,
height, glucose, and left atrial size were all associated with an
increased risk of AF. The use of ß-blockers and high levels of
alcohol use, cholesterol, and forced expiratory volume in 1
second were associated with a reduced risk of AF.
Conclusions The incidence of AF in older adults may be higher than estimated by previous population studies. Left atrial size appears to be an important risk factor, and the control of blood pressure and glucose may be important in preventing the development of AF.
Key Words: fibrillation • atrial flutter • epidemiology • follow-up studies • risk factors
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W. P. Abhayaratna, J. B. Seward, C. P. Appleton, P. S. Douglas, J. K. Oh, A. J. Tajik, and T. S.M. Tsang Left Atrial Size: Physiologic Determinants and Clinical Applications J. Am. Coll. Cardiol., June 20, 2006; 47(12): 2357 - 2363. [Abstract] [Full Text] [PDF]
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I. Kehat, R. Heinrich, O. Ben-Izhak, H. Miyazaki, J. S. Gutkind, and A. Aronheim Inhibition of basic leucine zipper transcription is a major mediator of atrial dilatation Cardiovasc Res, June 1, 2006; 70(3): 543 - 554. [Abstract] [Full Text] [PDF]
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I. R. Hanna, B. Heeke, H. Bush, L. Brosius, D. King-Hageman, J. F. Beshai, and J. J. Langberg The Relationship Between Stature and the Prevalence of Atrial Fibrillation in Patients With Left Ventricular Dysfunction J. Am. Coll. Cardiol., April 18, 2006; 47(8): 1683 - 1688. [Abstract] [Full Text] [PDF]
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J. Heeringa, D. A.M. van der Kuip, A. Hofman, J. A. Kors, G. van Herpen, B. H.Ch. Stricker, T. Stijnen, G. Y.H. Lip, and J. C.M. Witteman Prevalence, incidence and lifetime risk of atrial fibrillation: the Rotterdam study Eur. Heart J., April 2, 2006; 27(8): 949 - 953. [Abstract] [Full Text] [PDF]
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A. R. Cappola, L. P. Fried, A. M. Arnold, M. D. Danese, L. H. Kuller, G. L. Burke, R. P. Tracy, and P. W. Ladenson Thyroid Status, Cardiovascular Risk, and Mortality in Older Adults JAMA, March 1, 2006; 295(9): 1033 - 1041. [Abstract] [Full Text] [PDF]
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H.-R. Neuberger, U. Schotten, Y. Blaauw, D. Vollmann, S. Eijsbouts, A. van Hunnik, and M. Allessie Chronic Atrial Dilation, Electrical Remodeling, and Atrial Fibrillation in the Goat J. Am. Coll. Cardiol., February 7, 2006; 47(3): 644 - 653. [Abstract] [Full Text] [PDF]
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K. J. Mukamal, J. S. Tolstrup, J. Friberg, G. Jensen, and M. Gronbaek Alcohol Consumption and Risk of Atrial Fibrillation in Men and Women: The Copenhagen City Heart Study Circulation, September 20, 2005; 112(12): 1736 - 1742. [Abstract] [Full Text] [PDF]
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B. Olshansky, E. N. Heller, L. B. Mitchell, M. Chandler, W. Slater, M. Green, M. Brodsky, P. Barrell, H. L. Greene, and and the AFFIRM Investigators Are Transthoracic Echocardiographic Parameters Associated With Atrial Fibrillation Recurrence or Stroke?: Results From the Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) Study J. Am. Coll. Cardiol., June 21, 2005; 45(12): 2026 - 2033. [Abstract] [Full Text] [PDF]
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E. P. Anyukhovsky, E. A. Sosunov, P. Chandra, T. S. Rosen, P. A. Boyden, P. Danilo Jr., and M. R. Rosen Age-associated changes in electrophysiologic remodeling: a potential contributor to initiation of atrial fibrillation Cardiovasc Res, May 1, 2005; 66(2): 353 - 363. [Abstract] [Full Text] [PDF]
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M. Lehto, S. Snapinn, K. Dickstein, K. Swedberg, M. S. Nieminen, and on behalf of the OPTIMAAL investigators Prognostic risk of atrial fibrillation in acute myocardial infarction complicated by left ventricular dysfunction: the OPTIMAAL experience Eur. Heart J., February 2, 2005; 26(4): 350 - 356. [Abstract] [Full Text] [PDF]
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H.-R. Neuberger, U. Schotten, S. Verheule, S. Eijsbouts, Y. Blaauw, A. van Hunnik, and M. Allessie Development of a Substrate of Atrial Fibrillation During Chronic Atrioventricular Block in the Goat Circulation, January 4, 2005; 111(1): 30 - 37. [Abstract] [Full Text] [PDF]
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L. Frost and P. Vestergaard Alcohol and Risk of Atrial Fibrillation or Flutter: A Cohort Study Arch Intern Med, October 11, 2004; 164(18): 1993 - 1998. [Abstract] [Full Text] [PDF]
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J. M. Leung, W. H. Bellows, and N. B. Schiller Impairment of left atrial function predicts post-operative atrial fibrillation after coronary artery bypass graft surgery Eur. Heart J., October 2, 2004; 25(20): 1836 - 1844. [Abstract] [Full Text] [PDF]
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A. Abidov, R. Hachamovitch, A. Rozanski, S. W. Hayes, M. M. Santos, M. G. Sciammarella, I. Cohen, J. Gerlach, J. D. Friedman, G. Germano, et al. Prognostic implications of atrial fibrillation in patients undergoing myocardial perfusion single-photon emission computed tomography J. Am. Coll. Cardiol., September 1, 2004; 44(5): 1062 - 1070. [Abstract] [Full Text] [PDF]
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D. M. Lloyd-Jones, T. J. Wang, E. P. Leip, M. G. Larson, D. Levy, R. S. Vasan, R. B. D'Agostino, J. M. Massaro, A. Beiser, P. A. Wolf, et al. Lifetime Risk for Development of Atrial Fibrillation: The Framingham Heart Study Circulation, August 31, 2004; 110(9): 1042 - 1046. [Abstract] [Full Text] [PDF]
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D. Mozaffarian, B. M. Psaty, E. B. Rimm, R. N. Lemaitre, G. L. Burke, M. F. Lyles, D. Lefkowitz, and D. S. Siscovick Fish Intake and Risk of Incident Atrial Fibrillation Circulation, July 27, 2004; 110(4): 368 - 373. [Abstract] [Full Text] [PDF]
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P. L. L'Allier, A. Ducharme, P.-F. Keller, H. Yu, M.-C. Guertin, and J.-C. Tardif Angiotensin-converting enzyme inhibition in hypertensive patients is associated with a reduction in the occurrence of atrial fibrillation J. Am. Coll. Cardiol., July 7, 2004; 44(1): 159 - 164. [Abstract] [Full Text] [PDF]
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C. S. Fox, H. Parise, R. B. D'Agostino Sr, D. M. Lloyd-Jones, R. S. Vasan, T. J. Wang, D. Levy, P. A. Wolf, and E. J. Benjamin Parental Atrial Fibrillation as a Risk Factor for Atrial Fibrillation in Offspring JAMA, June 16, 2004; 291(23): 2851 - 2855. [Abstract] [Full Text] [PDF]
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C. W. Israel, G. Gronefeld, J. R. Ehrlich, Y.-G. Li, and S. H. Hohnloser Long-term risk of recurrent atrial fibrillation as documented by an implantable monitoring device: Implications for optimal patient care J. Am. Coll. Cardiol., January 7, 2004; 43(1): 47 - 52. [Abstract] [Full Text] [PDF]
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R. L. McNamara, L. J. Tamariz, J. B. Segal, and E. B. Bass Management of Atrial Fibrillation: Review of the Evidence for the Role of Pharmacologic Therapy, Electrical Cardioversion, and Echocardiography Ann Intern Med, December 16, 2003; 139(12): 1018 - 1033. [Abstract] [Full Text] [PDF]
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R. J. Aviles, D. O. Martin, C. Apperson-Hansen, P. L. Houghtaling, P. Rautaharju, R. A. Kronmal, R. P. Tracy, D. R. Van Wagoner, B. M. Psaty, M. S. Lauer, et al. Inflammation as a Risk Factor for Atrial Fibrillation Circulation, December 16, 2003; 108(24): 3006 - 3010. [Abstract] [Full Text] [PDF]
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R. J. Damiano Jr, S. L. Gaynor, M. Bailey, S. Prasad, J. L. Cox, J. P. Boineau, and R. P. Schuessler The long-term outcome of patients with coronary disease and atrial fibrillation undergoing the cox maze procedure J. Thorac. Cardiovasc. Surg., December 1, 2003; 126(6): 2016 - 2021. [Abstract] [Full Text] [PDF]
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E. Acebo, J. F. Val-Bernal, J. J. Gomez-Roman, and J. M. Revuelta Clinicopathologic Study and DNA Analysis of 37 Cardiac Myxomas: A 28-Year Experience Chest, May 1, 2003; 123(5): 1379 - 1385. [Abstract] [Full Text] [PDF]
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H. Sinno, K. Derakhchan, D. Libersan, Y. Merhi, T. K. Leung, and S. Nattel Atrial Ischemia Promotes Atrial Fibrillation in Dogs Circulation, April 15, 2003; 107(14): 1930 - 1936. [Abstract] [Full Text] [PDF]
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R. L. Page, T. W. Tilsch, S. J. Connolly, D. J. Schnell, S. R. Marcello, W. E. Wilkinson, E. L.C. Pritchett, and for the Azimilide Supraventricular Arrhythmia Prog Asymptomatic or "Silent" Atrial Fibrillation: Frequency in Untreated Patients and Patients Receiving Azimilide Circulation, March 4, 2003; 107(8): 1141 - 1145. [Abstract] [Full Text] [PDF]
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