CLARIFY Registry: NOAF Common, Increases Risk in Patients With Chronic Coronary Syndromes

New onset atrial fibrillation (NOAF) is common in patients with chronic coronary syndromes (CCS) and it is strongly associated with worse outcomes, according to a clinical research study published Aug. 27 in the European Heart Journal.

Alexandre Gautier, MD, et al., used data from 29,001 outpatients with CCS and no diagnosis of AFib in the international CLARIFY registry to examine the incidence and predictors of NOAF and its impact on cardiovascular outcomes compared with patients in sinus rhythm.

Results showed that 1,453 patients (5%) were diagnosed with NOAF, defined as at least one episode of AFib/flutter, during the five-year follow-up. The incidence rate was 1.12 per 100 patient-years. Patients diagnosed with NOAF were older (68.3 vs. 63.4 years; p<0.001), more often Caucasian (76.3% vs. 63.3%; p<0.001) and had more risk factors including smoking, diabetes and treated hypertension.

Independent risk factors for NOAF were increasing age, increasing body mass index, low estimated glomerular filtration rate, Caucasian ethnicity, alcohol intake and low left ventricular ejection fraction. High triglycerides were associated with lower incidence of NOAF.

Looking at cardiovascular outcomes, NOAF was associated with a substantial increased risk. The adjusted hazard ratio was 2.01 for the composite of cardiovascular death, nonfatal myocardial infarction (MI) or nonfatal stroke; and 2.61 for cardiovascular death, 1.64 for nonfatal MI, 2.27 for all-cause death, 8.44 for hospitalization for heart failure and 4.46 for major bleeding.

The authors note that the marked increased risk of major adverse events associated with AFib "weighs heavily on the prognosis of CCS patients and on healthcare systems." More research is needed on the impact of more intensive preventive measures and more systematic screening for AFib in the CCS population.

Clinical Topics: Arrhythmias and Clinical EP, Diabetes and Cardiometabolic Disease, Dyslipidemia, Heart Failure and Cardiomyopathies, Atrial Fibrillation/Supraventricular Arrhythmias, Hypertriglyceridemia, Lipid Metabolism, Acute Heart Failure

Keywords: Atrial Fibrillation, Stroke Volume, Glomerular Filtration Rate, Ventricular Function, Left, Myocardial Infarction, Heart Failure, Triglycerides

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