Risk of Death and Cardiovascular Events in Initially Healthy Women With New-Onset Atrial Fibrillation

Study Questions:

Does atrial fibrillation (AF) affect prognosis in middle-aged women?

Methods:

Periodic comprehensive questionnaires inquiring about health status were provided to 34,722 women (median age 53 years) initially free of cardiovascular disease enrolled in the Women’s Health Study. Medical records were reviewed whenever AF events were noted on a questionnaire. The primary outcomes were all-cause, cardiovascular, and noncardiovascular mortality. The median duration of follow-up was 15.4 years.

Results:

New-onset AF occurred in 1,011 women (2.9%). The AF was paroxysmal in 65% and the CHADS2 score was 0-1 in 70%. Warfarin was prescribed for 53% of women, a beta-blocker for 50%, calcium channel blocker for 23%, and a rhythm-control agent for 30%. After adjusting for age, AF was associated with a 2.2-fold higher risk of all-cause mortality, a 4.7-fold higher risk of cardiovascular mortality, and a 1.6-fold higher risk of noncardiovascular mortality. After adjustment for multiple comorbidities, AF independently was associated with a 1.7-fold higher risk of all-cause mortality, 2.6-fold higher risk of cardiovascular mortality, and a 1.4-fold higher risk of noncardiovascular mortality.

Conclusions:

The authors concluded that AF is associated with a higher risk of death in woman, even after adjustment for comorbidities.

Perspective:

The results suggest that prevention of AF could improve survival. However, the extent to which modification of risk factors for AF (e.g., hypertension, obesity, obstructive sleep apnea) actually prevents AF and reduces the risk of AF-related mortality is unclear.

Clinical Topics: Prevention, Hypertension

Keywords: Risk, Follow-Up Studies, Comorbidity, Cardiovascular Diseases, Women's Health, Hypertension


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