Abstract 12822: Long-Term Cardiovascular Outcomes in Patients with Atrial Fibrillation and Atherothrombosis in the REACH Registry
Background: Patients with atrial fibrillation (AF) are at increased risk of thromboembolic events. The long-term prognostic implications of AF in patients with established atherothrombosis are unknown.
Methods: We compared 4-year CV outcomes in patients with and without a history of atrial fibrillation recorded at their baseline visit in the REACH Registry, an international, prospective cohort of patients with established atherosclerotic arterial disease (CAD, CVD, PVD) or at least 3 risk factors (RFO).
Results: AF status and 4-year follow-up data were available on 43,011 patients. The prevalence of AF at baseline was 10.3% (n=4,410). Overall, patients with AF had approximately a 2-fold increase in the composite of CV death, MI, and stroke compared with patients without AF after adjustment for age, gender, hypertension, hypercholesterolemia, diabetes, and smoking (20.0% vs. 10.2%: RR 1.96, 95% CI 1.84-2.09). This significant increased risk was observed both in patients with established atherothrombosis (CAD: RR 1.95, 95% CI 1.80-2.11; CVD: RR 1.70, 95% CI 1.54-1.87; PVD: RR 1.76, 95% CI 1.50-2.06) and those with multiple risk factors (RFO: RR 2.24, 95% CI 1.76-2.87). Only 52% of patients with a history of AF at baseline were receiving anticoagulation.
Conclusions: Patients with both AF and atherothrombosis have particularly high long-term CV risk. Despite this increased risk, almost half of all patients with AF throughout the world do not receive guideline recommended anticoagulation, highlighting an important public health priority.
- © 2011 by American Heart Association, Inc.