Asymptomatic Atrial Fibrillation: Clinical Correlates, Management, and Outcomes in the EORP-AF Pilot General Registry - 24/04/15
, Cecile Laroche, MSc b, Igor Diemberger, MD, PhD a, Elisa Fantecchi, MD a, Mircea Ioachim Popescu, MD, PhD c, Lars Hvilsted Rasmussen, MD, PhD d, Gianfranco Sinagra, MD e, Lucian Petrescu, MD, PhD f, Luigi Tavazzi, MD g, Aldo P. Maggioni, MD h, Gregory Y.H. Lip, MD iAbstract |
Objective |
Atrial fibrillation is often asymptomatic, but outcomes require further characterization. The study objective was to investigate the clinical presentation, management, and outcomes in asymptomatic and symptomatic patients with atrial fibrillation who were prospectively enrolled in the EurObservational Research Programme – Atrial Fibrillation (EORP-AF) Pilot General Registry.
Methods |
A total of 3119 patients were enrolled, and 1237 (39.7%) were asymptomatic (European Heart Rhythm Association [EHRA] score I). Among symptomatic patients, 963 (51.2%) had mild symptoms (EHRA score II) and 919 (48.8%) had severe or disabling symptoms (EHRA III-IV). Permanent atrial fibrillation was 3-fold more common in asymptomatic patients than in symptomatic patients.
Results |
On multivariate analysis, male gender (odds ratio [OR], 1.630; 95% confidence interval [CI], 1.384-1.921), older age (OR, 1.019; 95% CI, 1.012-1.026), previous myocardial infarction (OR, 1.681; 95% CI, 1.350-2.093), and limited physical activity (OR, 1.757; 95% CI, 1.495-2.064) were associated significantly with asymptomatic (EHRA I) atrial fibrillation. Fully asymptomatic atrial fibrillation (absence of current and previous symptoms) was present in 520 patients (16.7%) and was associated independently with male gender, age, and previous myocardial infarction. Appropriate guideline-based prescription of oral anticoagulants was lower in these patients, and aspirin was prescribed more frequently. Mortality at 1 year was more than 2-fold higher in asymptomatic patients compared with symptomatic patients (9.4% vs 4.2%, P < .0001) and was associated independently with older age and comorbidities, including chronic kidney disease and chronic heart failure.
Conclusions |
Asymptomatic atrial fibrillation is common in daily cardiology practice and is associated with elderly age, more comorbidities, and high thromboembolic risks. A higher 1-year mortality was found in asymptomatic patients compared with symptomatic patients.
Le texte complet de cet article est disponible en PDF.Keywords : Atrial fibrillation, Bleeding, Mortality, Registry, Stroke
Plan
| Funding: None. |
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| Conflict of Interest: GB received a small speaker's fee from Boehringer, Medtronic Inc, and Boston Scientific. LHR is on the speakers bureaus for Bayer, BMS/Pfizer, Janssen Pharmaceuticals, Takeda, Roche Diagnostics, and Boehringer Ingelheim. LT is a consultant and speakers bureau member for Servier and a Committee Member for Servier, Medtronic Inc, St Jude Medical, CVIE Therapeutics, Boston Scientific, Vifor Pharma, and Cardiorentis. GYHL is a consultant for Bayer, Medtronic Inc, Sanofi, BMS/Pfizer, Daiichi-Sankyo, and Boehringer Ingelheim, and has been a speaker for Bayer, BMS/Pfizer, Boehringer Ingelheim, Daiichi-Sankyo, and Medtronic Inc. The remaining authors have no conflicts of interest associated with the work presented in this manuscript. |
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| Authorship: All authors had access to the data and played a role in writing this manuscript. |
Vol 128 - N° 5
P. 509 - mai 2015 Retour au numéro
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