[Impact of chronic atrial fibrillation on cardiovacular mortality]

Abstract

The largest cohort studies and a number of other epidemiological or clinical studies have found an increased risk of total, cardiovascular and stroke mortality in patients (both men and women of every age) with chronic non-rheumatic atrial fibrillation (AF) compared to heterogeneous individuals in normal sinus rhythm. These studies suggested that AF increases the probability of death without changing the mode of death. Many excess deaths due to non-rheumatic AF occur soon after the diagnosis of the arrhythmia. Non-rheumatic AF is complicated by the heterogeneity of the underlying heart disease and accompanying medications. Prognosis in non-rheumatic AF is dependent upon the age of the patients and the underlying cardiac conditions but non-rheumatic AF is a potent risk factor for stroke. Stroke in patients with non-rheumatic AF is generally more severe and induces higher mortality. A recent Framingham study has shown that an increased mortality rate persists when adjusted for age, hypertension, smoking, myocardial infarction, congestive heart failure, and stroke or transient ischemic attacks. These results demonstrate that non-rheumatic AF is independently associated with a 50 to 90% increase in the risk of death. Also the excess mortality observed in patients with chronic lone AF supports the independent role of the arrhythmia. The higher incidence of a chronic arrhythmia and the known complications of this condition pose serious problems for health care as our population ages. Passive acceptance of non-rheumatic AF is not correct. In all patients with non-rheumatic AF, restoring and maintaining sinus rhythm for as long as possible needs to be taken into serious consideration. New antiarrhythmic drugs and new strategies for the management of non-rheumatic AF are accumulating. When the arrhythmia is chronic, correct anticoagulant prophylaxis is a must, as several randomized trials have demonstrated a significant reduction in thromboembolic stroke incidence and related mortality with an acceptable hemorrhagic risk by using warfarin.