Department of Medicine, Division of Cardiovascular Medicine; Department of Quantitative Health Sciences; Meyers Primary Care Institute
Aged; Atrial Fibrillation; Female; Heart Failure; Humans; Male; Prognosis; Stroke
Cardiology | Cardiovascular Diseases | Epidemiology
BACKGROUND: Atrial fibrillation (AF) patterns and their relations with long-term prognosis are uncertain, partly because pattern definitions are challenging to implement in longitudinal data sets. We developed a novel AF classification algorithm and examined AF patterns and outcomes in the community.
METHODS AND RESULTS: We characterized AF patterns between 1980 and 2005 among Framingham Heart Study participants who survived >/= 1 year after diagnosis. We classified participants based on their pattern within the first 2 years after detection as having AF without recurrence, recurrent AF, or sustained AF. We examined associations between AF patterns and 10-year survival using proportional hazards regression. Among 612 individuals with AF, mean age was 72.5 +/- 10.8 years, and 53% were men. Of these, 478 participants had >/= 2 electrocardiograms (median, 3; limits 2 to 23) within 2 years after initial AF and were classified as having AF without 2-year recurrence (n = 63, 10%), recurrent AF (n = 162, 26%) or sustained AF (n = 207, 34%), although some (n = 46, 8%) were indeterminate. Of 432 classified participants, 363 died, 75 had strokes, and 110 were diagnosed with heart failure during the next 10 years. Relative to individuals without AF recurrence, the multivariable-adjusted mortality was higher among people with recurrent AF (hazard ratio [HR], 2.04; 95% confidence interval [CI], 1.26 to 3.29) and sustained AF (HR, 2.36; 95% CI, 1.49 to 3.75).
CONCLUSIONS: In our community-based AF sample, only 10% had AF without early-term (2-year) recurrence. Compared with individuals without 2-year AF recurrences, the 10-year prognosis was worse for individuals with either sustained or recurrent AF. Our proposed AF classification algorithm may be applicable in longitudinal data sets.
Rights and Permissions
Copyright 2013 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell. This is an Open Access article under the terms of the Creative Commons Attribution‐NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
DOI of Published Version
Lubitz SA, Moser C, Sullivan L, Rienstra M, Fontes JD, Villalon ML, Pai M, McManus DD, Schnabel RB, Magnani JW, Yin X, Levy D, Pencina MJ, Larson MG, Ellinor PT, Benjamin EJ. Atrial fibrillation patterns and risks of subsequent stroke, heart failure, or death in the community. J Am Heart Assoc. 2013 Sep 3;2(5):e000126. doi: 10.1161/JAHA.113.000126. Link to article on publisher's site
Journal of the American Heart Association
Lubitz SA, Moser CB, Sullivan L, Rienstra M, Fontes JD, Villalon ML, Pai M, McManus DD, Schnabel RB, Magnani JW, Yin X, Levy D, Pencina MJ, Larson MG, Ellinor PT, Benjamin EJ. (2013). Atrial fibrillation patterns and risks of subsequent stroke, heart failure, or death in the community. University of Massachusetts Medical School Faculty Publications. https://doi.org/10.1161/JAHA.113.000126. Retrieved from https://escholarship.umassmed.edu/faculty_pubs/305