TY - JOUR
T1 - Characteristics and outcomes of atrial fibrillation in patients without traditional risk factors
T2 - An RE-LY AF registry analysis
AU - Kloosterman, Mariëlle
AU - Oldgren, Jonas
AU - Conen, David
AU - Wong, Jorge A.
AU - Connolly, Stuart J.
AU - Avezum, Alvaro
AU - Yusuf, Salim
AU - Ezekowitz, Michael D.
AU - Wallentin, Lars
AU - Ntep-Gweth, Marie
AU - Joseph, Philip
AU - Barrett, Tyler W.
AU - Tanosmsup, Supachai
AU - McIntyre, William F.
AU - Lee, Shun Fu
AU - Parkash, Ratika
AU - Amit, Guy
AU - Grinvalds, Alex
AU - Van Gelder, Isabelle C.
AU - Healey, Jeff S.
N1 - Funding Information:
Conflict of interest: T.W.B. reports research support for the Centers for Disease Control/Tennessee Department of Health and Portola; paid consulting work with Red Bull. R.P. reports research grants from Abbott Medical, Medtronic and Pfizer. J.S.H. reports research grants from Boehringer Ingelheim, Bristol-Meyers-Squibb, Pfizer, Medtronic, St. Jude Medical, and Boston Scientific. All other authors have no conflict of interest in relation to the present article.
Funding Information:
J.S.H. is the Population Health Research Institute Chair of Cardiology Research and the recipient of a Heart and Stroke Foundation of Ontario Mid-Career Award (MC7450). D.C. holds a McMaster University Department of Medicine Mid-Career Research Award. His work was supported by the Hamilton Health Sciences RFA Strategic Initiative Program. I.C.V.G.7’s work was funded by the Netherlands Cardiovascular Research Initiative: an initiative with support of the Dutch Heart Foundation, CVON 2014-9: Reappraisal of Atrial Fibrillation: interaction between hyperCoagulability, Electrical remodelling, and Vascular destabilization in the progression of AF (RACE V). S.Y. holds the Marion Burke Chair of the Heart and Stroke Foundation of Canada. W.F.M. holds fellowship awards from the Canadian Stroke Prevention Intervention Network (C-SPIN) and the Canadian Institutes of Health Research (CIHR).
Publisher Copyright:
© 2019 Published on behalf of the European Society of Cardiology. All rights reserved. The Author(s) 2020. For permissions, please email: journals.permissions@oup.com.
PY - 2020/6/1
Y1 - 2020/6/1
N2 - Aims: Data on patient characteristics, prevalence, and outcomes of atrial fibrillation (AF) patients without traditional risk factors, often labelled 'lone AF', are sparse. Methods and results: The RE-LY AF registry included 15 400 individuals who presented to emergency departments with AF in 47 countries. This analysis focused on patients without traditional risk factors, including age ≥60 years, hypertension, coronary artery disease, heart failure, left ventricular hypertrophy, congenital heart disease, pulmonary disease, valve heart disease, hyperthyroidism, and prior cardiac surgery. Patients without traditional risk factors were compared with age- and region-matched controls with traditional risk factors (1:3 fashion). In 796 (5%) patients, no traditional risk factors were present. However, 98% (779/796) had less-established or borderline risk factors, including borderline hypertension (130-140/80-90 mmHg; 47%), chronic kidney disease (eGFR < 60 mL/min; 57%), obesity (body mass index > 30; 19%), diabetes (5%), excessive alcohol intake (>14 units/week; 4%), and smoking (25%). Compared with patients with traditional risk factors (n = 2388), patients without traditional risk factors were more often men (74% vs. 59%, P < 0.001) had paroxysmal AF (55% vs. 37%, P < 0.001) and less AF persistence after 1 year (21% vs. 49%, P < 0.001). Furthermore, 1-year stroke occurrence rate (0.6% vs. 2.0%, P = 0.013) and heart failure hospitalizations (0.9% vs. 12.5%, P < 0.001) were lower. However, risk of AF-related re-hospitalization was similar (18% vs. 21%, P = 0.09). Conclusion: Almost all patients without traditionally defined AF risk factors have less-established or borderline risk factors. These patients have a favourable 1-year prognosis, but risk of AF-related re-hospitalization remains high. Greater emphasis should be placed on recognition and management of less-established or borderline risk factors.
AB - Aims: Data on patient characteristics, prevalence, and outcomes of atrial fibrillation (AF) patients without traditional risk factors, often labelled 'lone AF', are sparse. Methods and results: The RE-LY AF registry included 15 400 individuals who presented to emergency departments with AF in 47 countries. This analysis focused on patients without traditional risk factors, including age ≥60 years, hypertension, coronary artery disease, heart failure, left ventricular hypertrophy, congenital heart disease, pulmonary disease, valve heart disease, hyperthyroidism, and prior cardiac surgery. Patients without traditional risk factors were compared with age- and region-matched controls with traditional risk factors (1:3 fashion). In 796 (5%) patients, no traditional risk factors were present. However, 98% (779/796) had less-established or borderline risk factors, including borderline hypertension (130-140/80-90 mmHg; 47%), chronic kidney disease (eGFR < 60 mL/min; 57%), obesity (body mass index > 30; 19%), diabetes (5%), excessive alcohol intake (>14 units/week; 4%), and smoking (25%). Compared with patients with traditional risk factors (n = 2388), patients without traditional risk factors were more often men (74% vs. 59%, P < 0.001) had paroxysmal AF (55% vs. 37%, P < 0.001) and less AF persistence after 1 year (21% vs. 49%, P < 0.001). Furthermore, 1-year stroke occurrence rate (0.6% vs. 2.0%, P = 0.013) and heart failure hospitalizations (0.9% vs. 12.5%, P < 0.001) were lower. However, risk of AF-related re-hospitalization was similar (18% vs. 21%, P = 0.09). Conclusion: Almost all patients without traditionally defined AF risk factors have less-established or borderline risk factors. These patients have a favourable 1-year prognosis, but risk of AF-related re-hospitalization remains high. Greater emphasis should be placed on recognition and management of less-established or borderline risk factors.
KW - Atrial fibrillation hospitalization
KW - Borderline risk factors
KW - Less-established risk factors
KW - Lone atrial fibrillation
KW - Registry
KW - Substrate
UR - http://www.scopus.com/inward/record.url?scp=85086051549&partnerID=8YFLogxK
U2 - 10.1093/europace/euz360
DO - 10.1093/europace/euz360
M3 - Article
C2 - 32215649
AN - SCOPUS:85086051549
VL - 22
SP - 870
EP - 877
JO - Europace
JF - Europace
SN - 1099-5129
IS - 6
ER -
