Abstract 18129: Risk Factors of the Progression from Paroxysmal or Persistent to Permanent Atrial Fibrillation. Evaluation of the HATCH Score in a Cohort of Unselected Patients.
Recently, the HATCH score has been proposed to identify patients with atrial fibrillation (AF) likely to progress to sustained forms of AF. It was also suggested that the score should be validated in another population of AF patients. Our objective was thus to evaluate the HATCH score in a large contemporary series of unselected AF patients in clinical practice and to identify other possible factors leading to permanent AF.
Methods: All patients with AF seen in our institution between 2000 and 2007 were identified in a database and followed up for mortality. HATCH socre — acronym for hypertension, age >75, TIA or stroke (2 points), chronic obstructive pulmonary disease and heart failure (2 points) — was calculated for each patient.
Results: Among 4058 patients with a follow-up > 30 days (age 71±14 years; 2523 men [62%]), 2167 had paroxysmal AF, 220 had persistent AF, and 1671 had permanent AF. During a follow-up of 946±767 days, 553 of them died. Permanent AF was associated with a higher risk of death compared to paroxysmal AF (relative risk=1.45, 95% CI 1.30–1.62) and persistent AF (relative risk=2.8, 95%CI 2.16–3.81) (both p<0.0001). Among 2167 patients with paroxysmal or persistent AF, 307 had progression to permanent AF (mean annual rate of 8.8 % with steady progression). Each item of the HATCH score was associated with a risk of progression to permanent AF except for the history of stroke. Overall, the HATCH score was a significant and powerful predictor of progression (relative risk for 1 unit =1.37, 95%CI 1.27–1.47, p<0.0001). In addition to the HATCH score, the factors independently associated with progression to permanent AF were the number of electrical cardioversion (p<0.0001), presence of dilated cardiomyopathy (p=0.002) and prosthetic heart valve (p=0.02).
Conclusions: In patients with paroxysmal or persistent AF, progression to permament AF is associated with a worse prognosis. The HATCH score seems an appropriate tool to identify the risk of evolution to permanent AF and may be improved if one also considers the presence of prosthetic heart valve or dilated cardiomyopathy. Considering the nature of these factors, one may conjecture that an early optimization of the treatment of heart failure may help to maintain sinus rhythm and may lead to a better survival.
- © 2010 by American Heart Association, Inc.