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Multicenter Study
. 2015 May 12;131(19):1648-55.
doi: 10.1161/CIRCULATIONAHA.114.014058. Epub 2015 Mar 13.

Long-term outcomes of secondary atrial fibrillation in the community: the Framingham Heart Study

Steven A Lubitz  1 , Xiaoyan Yin  2 , Michiel Rienstra  2 , Renate B Schnabel  2 , Allan J Walkey  2 , Jared W Magnani  2 , Faisal Rahman  2 , David D McManus  2 , Thomas M Tadros  2 , Daniel Levy  2 , Ramachandran S Vasan  2 , Martin G Larson  2 , Patrick T Ellinor  2 , Emelia J Benjamin  2
Affiliations
Multicenter Study

Long-term outcomes of secondary atrial fibrillation in the community: the Framingham Heart Study

Steven A Lubitz et al. Circulation. .

Abstract

Background: Guidelines have proposed that atrial fibrillation (AF) can occur as an isolated event, particularly when precipitated by a secondary, or reversible, condition. However, knowledge of long-term AF outcomes after diagnosis during a secondary precipitant is limited.

Methods and results: In 1409 Framingham Heart Study participants with new-onset AF, we examined associations between first-detected AF episodes occurring with and without a secondary precipitant and both long-term AF recurrence and morbidity. We selected secondary precipitants based on guidelines (surgery, infection, acute myocardial infarction, thyrotoxicosis, acute alcohol consumption, acute pericardial disease, pulmonary embolism, or other acute pulmonary disease). Among 439 patients (31%) with AF diagnosed during a secondary precipitant, cardiothoracic surgery (n=131 [30%]), infection (n=102 [23%]), noncardiothoracic surgery (n=87 [20%]), and acute myocardial infarction (n=78 [18%]) were most common. AF recurred in 544 of 846 eligible individuals without permanent AF (5-, 10-, and 15-year recurrences of 42%, 56%, and 62% with versus 59%, 69%, and 71% without secondary precipitants; multivariable-adjusted hazard ratio, 0.65 [95% confidence interval, 0.54-0.78]). Stroke risk (n=209/1262 at risk; hazard ratio, 1.13 [95% confidence interval, 0.82-1.57]) and mortality (n=1098/1409 at risk; hazard ratio, 1.00 [95% confidence interval, 0.87-1.15]) were similar between those with and without secondary precipitants, although heart failure risk was reduced (n=294/1107 at risk; hazard ratio, 0.74 [95% confidence interval, 0.56-0.97]).

Conclusions: AF recurs in most individuals, including those diagnosed with secondary precipitants. Long-term AF-related stroke and mortality risks were similar between individuals with and without secondary AF precipitants. Future studies may determine whether increased arrhythmia surveillance or adherence to general AF management principles in patients with reversible AF precipitants will reduce morbidity.

Keywords: atrial fibrillation; atrial flutter; epidemiology; heart failure; risk factors; stroke.

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Figures

Figure 1
Figure 1
Risk of recurrent atrial fibrillation by presence or absence of secondary atrial fibrillation precipitants. Cumulative incidence estimates were adjusted for the competing risk of death.
Figure 2
Figure 2
Risk of long-term morbidity by presence or absence of secondary atrial fibrillation precipitants. Panels display the cumulative risks of A) incident heart failure, B) incident stroke, and C) mortality by secondary atrial fibrillation precipitants. In A and B, cumulative incidence estimates were adjusted for the competing risk of death.
See this image and copyright information in PMC

Comment in

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