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Early Risk of Events After Atrial Fibrillation Diagnosis
Study Questions:
What is the risk of early major adverse events over 12 months following diagnosis of atrial fibrillation (AF)?
Methods:
The authors analyzed the GARFIELD-AF registry for the risk of events (death, stroke/systolic embolism, and major bleeding) in the first 12 month following diagnosis in 52,014 patients prospectively enrolled between March 2010 and August 2016.
Results:
Over 12 months from the time of diagnosis, 2,140 patients died (mortality rate, 4.3 per 100 person-years), of whom 288 (13.5%) died in the first month (6.8). Over 12 months, 657 patients suffered a stroke/systemic embolism (1.3%) and 411 had major bleeding (0.8%). During the first month, the rates (per 100 person-years) of stroke/systemic embolism and major bleed were 2.3 and 1.5, respectively. The elevated 1-month mortality rate was mostly attributable to cardiovascular mortality (3.5). The leading causes of early death were heart failure, sudden/unwitnessed death, acute coronary syndromes, infection/sepsis, and respiratory failure. Age, heart failure, prior stroke, history of cirrhosis, vascular disease, moderate-to-severe kidney disease, diabetes, and living in North or Latin America were independent predictors of a higher risk of early death, whereas anticoagulation and living in Europe or Asia were independent predictors of a lower risk of early death.
Conclusions:
Patients newly diagnosed with AF have a relatively high risk of early events, particularly cardiovascular mortality.
Perspective:
This study provides additional evidence that newly diagnosed AF patients are at higher risk of adverse events shortly after diagnosis. Ischemic stroke only modestly contributed to the excess of early mortality; the leading causes of early death were heart failure, sudden/unwitnessed death, and acute coronary syndromes. Unlike in the Framingham Heart Study, the increased risk was observed only in patients with a CHA2DS2-VASc score of ≥3. Among the independent predictors of early death, heart failure, diabetes, and vascular disease are potentially modifiable and should be targets for intervention.
Clinical Topics: Acute Coronary Syndromes, Anticoagulation Management, Arrhythmias and Clinical EP, Geriatric Cardiology, Heart Failure and Cardiomyopathies, Prevention, Anticoagulation Management and ACS, Anticoagulation Management and Atrial Fibrillation, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure
Keywords: Acute Coronary Syndrome, Anticoagulants, Arrhythmias, Cardiac, Atrial Fibrillation, Brain Ischemia, Diabetes Mellitus, Embolism, Geriatrics, Heart Failure, Hemorrhage, Kidney Diseases, Liver Cirrhosis, Respiratory Insufficiency, Risk, Secondary Prevention, Sepsis, Stroke, Vascular Diseases
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