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. 2014 Jan;35(4):250-6.
doi: 10.1093/eurheartj/eht483. Epub 2013 Nov 25.

Clinical course of atrial fibrillation in older adults: the importance of cardiovascular events beyond stroke

Jonathan P Piccini  1 , Bradley G Hammill, Moritz F Sinner, Adrian F Hernandez, Allan J Walkey, Emelia J Benjamin, Lesley H Curtis, Susan R Heckbert
Affiliations

Clinical course of atrial fibrillation in older adults: the importance of cardiovascular events beyond stroke

Jonathan P Piccini et al. Eur Heart J. 2014 Jan.

Abstract

Aims: Atrial fibrillation increases the risks of stroke, heart failure, and death, and anticoagulation therapy increases the risk of gastrointestinal haemorrhage. However, the relative event rates for these outcomes are not well described. We sought to define the risks of major clinical events in older adults after a new diagnosis of atrial fibrillation.

Methods and results: We undertook a population-based, retrospective cohort study of a nationally representative sample of fee-for-service Medicare beneficiaries 65 years or older with incident atrial fibrillation diagnosed between 1999 and 2007. The main outcome measures were mortality and hospitalization or emergency department care for heart failure, myocardial infarction, stroke, or gastrointestinal haemorrhage. Among 186 461 patients with atrial fibrillation and no recent hospitalizations for heart failure, myocardial infarction, stroke, or gastrointestinal haemorrhage, mortality was the most frequent of these major clinical events (19.5% at 1 year; 48.8% at 5 years). By 5 years, 13.7% of patients were hospitalized for heart failure, 7.1% developed new-onset stroke, and 5.7% had gastrointestinal haemorrhage. Myocardial infarction was less frequent (3.9% at 5 years). Rates of mortality, heart failure, myocardial infarction, stroke, and gastrointestinal bleeding increased with older age and higher CHADS2 scores. Among 44 479 patients with previous events, the 5-year risk of death was greatest among patients with recent bleeding events (70.1%) and stroke (63.7%) and lowest among those with recent myocardial infarction (54.9%).

Conclusion: After the diagnosis of incident atrial fibrillation in older adults, mortality was the most frequent major outcome during the first 5 years. Among non-fatal cardiovascular events, heart failure was the most common event.

Keywords: Atrial fibrillation; Heart failure; Mortality; Outcome assessment (health care).

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Figures

Figure 1
Figure 1
Observed cumulative incidence of events in the 5 years after the diagnosis of incident atrial fibrillation by study cohort. Numbers of patients at risk of death over time.
Figure 2
Figure 2
Observed cumulative incidence of events in the 5 years after the diagnosis of incident atrial fibrillation by setting of diagnosis in the primary study cohort. Numbers of patients at risk of death over time.
See this image and copyright information in PMC

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