Abstract 13665: Atrial Fibrillation Patterns in the Community and Risks of Stroke, Heart Failure, or Death
Background: Atrial fibrillation (AF) may occur as an isolated event, recur episodically, or be sustained without reversion to sinus rhythm. The frequencies of AF patterns in the community and their relations with long-term prognosis are uncertain.
Methods: We characterized the frequencies of AF patterns among participants in the Framingham Heart Study with a first-detected episode of AF between 1980 and 2005, all of whom were followed to 2008. Associations between AF patterns and long-term survival were examined using multivariable Cox proportional hazards regression analysis.
Results: Among the 612 individuals who survived at least one year after AF detection, the mean age was 72.5±10.8 years, and 327 (53%) were men. 478 participants had at least 2 ECGs (median=3, range 2-23) within two years of initial AF detection and were classified as having isolated first-detected AF (n=63, 13%), recurrent AF (n=162, 34%) or sustained AF (n=207, 43%), although some were indeterminate (n=46, 10%). Over the subsequent 10 years, 338 participants died, 69 had a stroke, and 97 were diagnosed with heart failure. The 10-year risk of death was higher among those with recurrent (HR 1.85; 95% CI, 1.14-3.01) and sustained AF (HR 2.06; 95% CI, 1.29-3.28) relative to those with isolated first-detected AF. No significant difference was observed between recurrent and sustained AF in the risk of death (P=0.49). In secondary analyses, the risk of heart failure was higher among those with recurrent as compared to first-detected AF only (HR 2.87; 95% CI, 1.23-6.68). The risk of stroke was not significantly different across AF patterns. The cumulative incidence of the composite of stroke, heart failure, or death is displayed in the Figure.
Conclusions: In our community-based sample, over one-third of individuals had recurrent and almost one-half had sustained AF early after AF detection. Long-term prognosis was significantly worse for those with either sustained or recurrent AF soon after AF detection.
- © 2011 by American Heart Association, Inc.