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Comparative Study
. 2005 Jul 11:5:20.
doi: 10.1186/1471-2261-5-20.

Predictors and prognosis of paroxysmal atrial fibrillation in general practice in the UK

Ana Ruigómez  1 , Saga Johansson, Mari-Ann Wallander, Luis Alberto García Rodríguez
Affiliations
Comparative Study

Predictors and prognosis of paroxysmal atrial fibrillation in general practice in the UK

Ana Ruigómez et al. BMC Cardiovasc Disord. .

Abstract

Background: Natural history of paroxysmal atrial fibrillation (AF) is not very well documented. Clinical experience suggests that paroxysmal AF could progress to chronic AF with estimates ranging between 15 and 30% over a period of 1-3 years. We performed an epidemiologic study to elucidate the natural history of paroxysmal AF, this study estimated its incidence in a general practice setting, identified associated factors and analyzed the progression into chronic AF as well as the mortality rate.

Methods: Using the UK General Practice Research Database (GPRD), we identified patients aged 40-89 years with a first-recorded episode of paroxysmal AF during 1996. Risk factors were assessed using 525 incident paroxysmal AF cases confirmed by the general practitioner (GP) and a random sample of controls. We follow-up paroxysmal AF patients and estimated their mortality rate and progression to chronic AF.

Results: The incidence of paroxysmal AF was 1.0 per 1,000 person-years. Major risk factors for paroxysmal AF were age and prior valvular heart disease, ischaemic heart disease, heart failure and hyperthyroidism. During a mean follow-up of 2.7 years, 70 of 418 paroxysmal AF patients with complete information progressed to chronic AF. Risk factors associated with progression were valvular heart disease (OR 2.7, 95% CI 1.2-6.0) and moderate to high alcohol consumption (OR 3.0, 95% CI 1.1-8.0). Paroxysmal AF patients did not carry an increased risk of mortality, compared to an age and sex matched sample of the general population. There was a suggestion of a small increased risk among patients progressing to chronic AF (RR 1.5, 96% CI 0.8-2.9).

Conclusion: Paroxysmal AF is a common arrhythmia in the general practice setting, increasing with age and commonly associated with other heart diseases. It sometimes is the initial presentation and then progress to chronic AF. A history of valvular heart disease and alcohol consumption are associated with this progression.

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Figures

Figure 1
Figure 1
Incidence of paroxysmal atrial fibrillation in comparison to chronic atrial fibrillation in UK General Practice [10].
Figure 2
Figure 2
Proportion of patients with paroxysmal atrial fibrillation progressing to chronic AF. Number of patients at risk and number of new chronic AF cases in each time period, in UK General Practice.
Figure 3
Figure 3
Risk of progression to chronic atrial fibrillation among paroxysmal atrial fibrillation patients (Odds ratio estimates adjusted by age and sex, using logistic regression).
See this image and copyright information in PMC

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