Advertisement

Age-Dependent Prognostic Impact of Paroxysmal Versus Sustained Atrial Fibrillation on the Incidence of Cardiac Death and Heart Failure Hospitalization (the Fushimi AF Registry)

      Data regarding the relation of the type of atrial fibrillation (AF) to the incidence of cardiac events remain scarce. This study sought to investigate the association of AF type with the incidences of cardiac death and heart failure (HF) hospitalization between paroxysmal and sustained (persistent/permanent) AF in the overall population and in age subgroups (≤74, 75 to 84, and ≥85 years), using the data from a Japanese community-based prospective survey, the Fushimi AF Registry. The participants started to be enrolled since March 2011, and follow-up data were available for 4,304 patients by the end of November 2017. Patients with sustained AF (n = 2,187, 50.8%) had more co-morbidities with higher mean CHA2DS2-VASc score than those with paroxysmal AF (n = 2,117, 49.2%) (sustained vs paroxysmal: 3.57 ± 1.69 vs 3.17 ± 1.67, p <0.001). During a median follow-up of 1,307 (interquartile range: 709 to 2,156) days, the composite of cardiac death and HF hospitalization occurred more frequently in those with sustained AF (event rate: 5.1 vs 2.8 per 100 person-years; p <0.001). On multivariate analysis, sustained AF was independently associated with higher incidence of this composite end point (adjusted hazard ratio [HR]: 1.35, 95% confidence interval [CI]: 1.12 to 1.63, p = 0.002). In age subgroups, this association was observed only in the younger AF patients (≤74 years) (adjusted HR: 2.03, 95% CI: 1.44 to 2.86, p <0.001), but not in the older subgroups (p = 0.018 for interaction). In conclusion, sustained AF was associated with higher incidence of the composite of cardiac death and HF hospitalization than paroxysmal AF, with different relations seen depending on age subgroups.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Al-Khatib SM
        • Thomas L
        • Wallentin L
        • Lopes RD
        • Gersh B
        • Garcia D
        • Ezekowitz J
        • Alings M
        • Yang H
        • Alexander JH
        • Flaker G
        • Hanna M
        • Granger CB
        Outcomes of apixaban vs. warfarin by type and duration of atrial fibrillation: results from the ARISTOTLE trial.
        Eur Heart J. 2013; 34: 2464-2471
        • Steinberg BA
        • Hellkamp AS
        • Lokhnygina Y
        • Patel MR
        • Breithardt G
        • Hankey GJ
        • Becker RC
        • Singer DE
        • Halperin JL
        • Hacke W
        • Nessel CC
        • Berkowitz SD
        • Mahaffey KW
        • Fox KA
        • Califf RM
        • Piccini JP
        • ROCKET-AF Steering Committee and Investigators
        Higher risk of death and stroke in patients with persistent vs. paroxysmal atrial fibrillation: results from the ROCKET-AF Trial.
        Eur Heart J. 2015; 36: 288-296
        • Link MS
        • Giugliano RP
        • Ruff CT
        • Scirica BM
        • Huikuri H
        • Oto A
        • Crompton AE
        • Murphy SA
        • Lanz H
        • Mercuri MF
        • Antman EM
        • Braunwald E
        • ENGAGE AF-TIMI 48 Investigators
        Stroke and mortality risk in patients with various patterns of atrial fibrillation: results from the ENGAGE AF-TIMI 48 Trial (effective anticoagulation with factor Xa next generation in atrial fibrillation-thrombolysis in myocardial infarction 48).
        Circ Arrhythm Electrophysiol. 2017; 10
        • Takabayashi K
        • Hamatani Y
        • Yamashita Y
        • Takagi D
        • Unoki T
        • Ishii M
        • Iguchi M
        • Masunaga N
        • Ogawa H
        • Esato M
        • Chun YH
        • Tsuji H
        • Wada H
        • Hasegawa K
        • Abe M
        • Lip GY
        • Akao M
        Incidence of stroke or systemic embolism in paroxysmal versus sustained atrial fibrillation: the Fushimi Atrial Fibrillation Registry.
        Stroke. 2015; 46: 3354-3361
        • Gomez-Outes A
        • Lagunar-Ruiz J
        • Terleira-Fernandez AI
        • Calvo-Rojas G
        • Suarez-Gea ML
        • Vargas-Castrillon E
        Causes of death in anticoagulated patients with atrial fibrillation.
        J Am Coll Cardiol. 2016; 68: 2508-2521
        • Bassand JP
        • Accetta G
        • Camm AJ
        • Cools F
        • Fitzmaurice DA
        • Fox KA
        • Goldhaber SZ
        • Goto S
        • Haas S
        • Hacke W
        • Kayani G
        • Mantovani LG
        • Misselwitz F
        • Ten Cate H
        • Turpie AG
        • Verheugt FW
        • Kakkar AK
        • GARFIELD-AF Investigators
        Two-year outcomes of patients with newly diagnosed atrial fibrillation: results from GARFIELD-AF.
        Eur Heart J. 2016; 37: 2882-2889
        • Fauchier L
        • Villejoubert O
        • Clementy N
        • Bernard A
        • Pierre B
        • Angoulvant D
        • Ivanes F
        • Babuty D
        • Lip GY
        Causes of death and influencing factors in patients with atrial fibrillation.
        Am J Med. 2016; 129: 1278-1287
        • An Y
        • Ogawa H
        • Yamashita Y
        • Ishii M
        • Iguchi M
        • Masunaga N
        • Esato M
        • Tsuji H
        • Wada H
        • Hasegawa K
        • Abe M
        • Lip GYH
        • Akao M
        Causes of death in Japanese patients with atrial fibrillation: the Fushimi Atrial Fibrillation Registry.
        Eur Heart J Qual Care Clin Outcomes. 2019; 5: 35-42
        • Wang TJ
        • Larson MG
        • Levy D
        • Vasan RS
        • Leip EP
        • Wolf PA
        • D'Agostino RB
        • Murabito JM
        • Kannel WB
        • Benjamin EJ
        Temporal relations of atrial fibrillation and congestive heart failure and their joint influence on mortality: the Framingham Heart Study.
        Circulation. 2003; 107: 2920-2925
        • Bai Y
        • Wang YL
        • Shantsila A
        • Lip GYH
        The global burden of atrial fibrillation and stroke: a systematic review of the clinical epidemiology of atrial fibrillation in Asia.
        Chest. 2017; 152: 810-820
        • Akao M
        • Chun YH
        • Wada H
        • Esato M
        • Hashimoto T
        • Abe M
        • Hasegawa K
        • Tsuji H
        • Furuke K
        • Fushimi AFRI
        Current status of clinical background of patients with atrial fibrillation in a community-based survey: the Fushimi AF Registry.
        J Cardiol. 2013; 61: 260-266
        • January CT
        • Wann LS
        • Calkins H
        • Chen LY
        • Cigarroa JE
        • Cleveland Jr., JC
        • Ellinor PT
        • Ezekowitz MD
        • Field ME
        • Furie KL
        • Heidenreich PA
        • Murray KT
        • Shea JB
        • Tracy CM
        • Yancy CW
        2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society.
        J Am Coll Cardiol. 2019; 74: 104-132
        • Kirchhof P
        • Benussi S
        • Kotecha D
        • Ahlsson A
        • Atar D
        • Casadei B
        • Castella M
        • Diener HC
        • Heidbuchel H
        • Hendriks J
        • Hindricks G
        • Manolis AS
        • Oldgren J
        • Popescu BA
        • Schotten U
        • Van Putte B
        • Vardas P
        • ESC Scientific Document Group
        2016 ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS.
        Eur Heart J. 2016; 37: 2893-2962
        • Ogawa H
        • An Y
        • Ikeda S
        • Aono Y
        • Doi K
        • Ishii M
        • Iguchi M
        • Masunaga N
        • Esato M
        • Tsuji H
        • Wada H
        • Hasegawa K
        • Abe M
        • Lip GYH
        • Akao M
        • Fushimi AFRI
        Progression from paroxysmal to sustained atrial fibrillation is associated with increased adverse events.
        Stroke. 2018; 49: 2301-2308
        • Yamashita Y
        • Hamatani Y
        • Esato M
        • Chun YH
        • Tsuji H
        • Wada H
        • Hasegawa K
        • Abe M
        • Lip GYH
        • Akao M
        Clinical characteristics and outcomes in extreme elderly (age >/= 85 years) Japanese patients with atrial fibrillation: the Fushimi AF Registry.
        Chest. 2016; 149: 401-412
        • Stein GY
        • Kremer A
        • Shochat T
        • Bental T
        • Korenfeld R
        • Abramson E
        • Ben-Gal T
        • Sagie A
        • Fuchs S
        The diversity of heart failure in a hospitalized population: the role of age.
        J Card Fail. 2012; 18: 645-653
        • Metra M
        • Cotter G
        • El-Khorazaty J
        • Davison BA
        • Milo O
        • Carubelli V
        • Bourge RC
        • Cleland JG
        • Jondeau G
        • Krum H
        • O'Connor CM
        • Parker JD
        • Torre-Amione G
        • van Veldhuisen DJ
        • Rainisio M
        • Kobrin I
        • McMurray JJ
        • Teerlink JR
        Acute heart failure in the elderly: differences in clinical characteristics, outcomes, and prognostic factors in the VERITAS Study.
        J Card Fail. 2015; 21: 179-188
        • Boriani G
        • Laroche C
        • Diemberger I
        • Fantecchi E
        • Popescu MI
        • Rasmussen LH
        • Dan GA
        • Kalarus Z
        • Tavazzi L
        • Maggioni AP
        • Lip GY
        ‘Real-world’ management and outcomes of patients with paroxysmal vs. non-paroxysmal atrial fibrillation in Europe: the EURObservational Research Programme-Atrial Fibrillation (EORP-AF) General Pilot Registry.
        Europace. 2016; 18: 648-657
        • Schnabel RB
        • Rienstra M
        • Sullivan LM
        • Sun JX
        • Moser CB
        • Levy D
        • Pencina MJ
        • Fontes JD
        • Magnani JW
        • McManus DD
        • Lubitz SA
        • Tadros TM
        • Wang TJ
        • Ellinor PT
        • Vasan RS
        • Benjamin EJ
        Risk assessment for incident heart failure in individuals with atrial fibrillation.
        Eur J Heart Fail. 2013; 15: 843-849
        • Potpara TS
        • Polovina MM
        • Licina MM
        • Marinkovic JM
        • Lip GY
        Predictors and prognostic implications of incident heart failure following the first diagnosis of atrial fibrillation in patients with structurally normal hearts: the Belgrade Atrial Fibrillation Study.
        Eur J Heart Fail. 2013; 15: 415-424
        • Suzuki S
        • Sagara K
        • Otsuka T
        • Matsuno S
        • Funada R
        • Uejima T
        • Oikawa Y
        • Yajima J
        • Koike A
        • Nagashima K
        • Kirigaya H
        • Sawada H
        • Aizawa T
        • Yamashita T
        A new scoring system for evaluating the risk of heart failure events in Japanese patients with atrial fibrillation.
        Am J Cardiol. 2012; 110: 678-682
        • Pandey A
        • Kim S
        • Moore C
        • Thomas L
        • Gersh B
        • Allen LA
        • Kowey PR
        • Mahaffey KW
        • Hylek E
        • Peterson ED
        • Piccini JP
        • Fonarow GC
        • ORBIT-AF Investigators and Patients
        Predictors and prognostic implications of incident heart failure in patients with prevalent atrial fibrillation.
        JACC Heart Fail. 2017; 5: 44-52
        • Marrouche NF
        • Brachmann J
        • Andresen D
        • Siebels J
        • Boersma L
        • Jordaens L
        • Merkely B
        • Pokushalov E
        • Sanders P
        • Proff J
        • Schunkert H
        • Christ H
        • Vogt J
        • Bansch D
        • Investigators C-A
        Catheter ablation for atrial fibrillation with heart failure.
        N Engl J Med. 2018; 378: 417-427
        • Charitos EI
        • Purerfellner H
        • Glotzer TV
        • Ziegler PD
        Clinical classifications of atrial fibrillation poorly reflect its temporal persistence: insights from 1,195 patients continuously monitored with implantable devices.
        J Am Coll Cardiol. 2014; 63: 2840-2848