Abstract 16811: Lack of Palpitation on Presentation with Atrial Fibrillation, a Novel Predictor of Poor Outcome
Objectives: It is well recognized that patients differ in the presentation symptoms that accompany atrial fibrillation (AF). Whether different symptom presentations can affect the outcome is not known. The aim of this study was to identify whether lack of palpitations among patients hospitalized with AF in a real-world population is associated with worse outcome.
Methods: Retrospective analysis of prospective registry of all patients hospitalized with AF in Qatar from 1991 through 2010 was made. Patients were divided into two groups according to the presence or absence of palpitation symptoms on presentation. Clinical characteristics and outcome were analyzed.
Results: During the 20-years period, 3850 patients were hospitalized for AF; 1724 (44.8%) had palpitations on presentation while 2126 (55.2%) had no palpitations. Patients who lacked palpitations were 9 years older, had more prevalence of diabetes mellitus (64.7% vs. 35.3%), underlying coronary artery disease (14.6%, vs. 6.2%) and severe left ventricular ejection fraction dysfunction on echocardiography (25.5% vs. 6.6%), (all; P value =0.001). There were 141 deaths among the group with no palpitations compared with 19 among the group with palpitations (6.6% versus 1.1%). Multivariate analysis of mortality predictors identified (lack of palpitations as an independent predictor of in-hospital mortality (relative risk 5.56; 95% confidence interval 1.20 - 25.0, p= 0.03)[see table].
Conclusions: Our study demonstrates for the first time that lack of palpitations as the presenting symptom of patients with AF is associated with worse in-hospital outcome independent of other risk factors or therapy. Further research is warranted to confirm and explain this novel observation.
- © 2012 by American Heart Association, Inc.