Mortality risk and temporal patterns of atrial fibrillation in the nationwide registry

Abstract Aims Persistent and permanent atrial fibrillation (AF) often occurs in the presence of multiple comorbidities and is linked to adverse outcomes. It is unclear whether the sustained pattern of AF itself is prognostic or if it is confounded by underlying comorbidities. Here, we tested the ass...

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Autores principales:	Sirin Apiyasawat, Sakaorat Kornbongkotmas, Ply Chichareon, Rungroj Krittayaphong, for the COOL‐AF Investigators
Formato:	article
Lenguaje:	EN
Publicado:	Wiley 2021
Materias:	atrial fibrillation atrial fibrillation type mortality registry stroke Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/7fdc30e60c0843b19c9b4b99e9f7fca0
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spelling	oai:doaj.org-article:7fdc30e60c0843b19c9b4b99e9f7fca02021-12-02T08:25:11ZMortality risk and temporal patterns of atrial fibrillation in the nationwide registry1883-21481880-427610.1002/joa3.12643https://doaj.org/article/7fdc30e60c0843b19c9b4b99e9f7fca02021-12-01T00:00:00Zhttps://doi.org/10.1002/joa3.12643https://doaj.org/toc/1880-4276https://doaj.org/toc/1883-2148Abstract Aims Persistent and permanent atrial fibrillation (AF) often occurs in the presence of multiple comorbidities and is linked to adverse outcomes. It is unclear whether the sustained pattern of AF itself is prognostic or if it is confounded by underlying comorbidities. Here, we tested the association between the temporal patterns of AF and the risks of ischemic stroke and all‐cause mortality. Methods and Results In a prospective multicenter cohort, 3046 non‐valvular AF patients were consecutively enrolled and followed for adverse outcomes of all‐cause mortality and ischemic stroke. The risks of both outcomes were adjusted for underlying comorbidities, and compared between the patterns of AF. At baseline, the patients were classified as paroxysmal (N = 963, 31.6%), persistent (N = 604, 19.8%), and permanent AF (N = 1479, 45.6%) according to the standard definition. Anticoagulants were administered in 75% of all patients and 83% of those with CHA2DS2‐VASc score ≥2 in males or ≥3 in females. During a mean follow up of 26 (SD 10.5) months, all‐cause mortality occurred less in paroxysmal AF (2.5 per 100 patient‐years) than in persistent AF (4.4 per 100 patient‐years; adjusted hazard ratio [HR] 0.66, 95% CI, 0.46‐0.96; P = .029) and permanent AF (4.1 per 100 patient‐years; adjusted HR 0.71, 95% CI, 0.52‐0.98; P = .036). The risk of ischemic stroke was similar across all patterns of AF. Conclusions In this multicenter cohort of AF patients, persistent and permanent AF was associated with higher all‐cause mortality than paroxysmal AF, independent of baseline comorbidities. Clinical Trial Registration Thai Clinical Trial Registration; Study ID: TCTR20160113002 (http://www.thaiclinicaltrials.org/show/TCTR20160113002).Sirin ApiyasawatSakaorat KornbongkotmasPly ChichareonRungroj Krittayaphongfor the COOL‐AF InvestigatorsWileyarticleatrial fibrillationatrial fibrillation typemortalityregistrystrokeDiseases of the circulatory (Cardiovascular) systemRC666-701ENJournal of Arrhythmia, Vol 37, Iss 6, Pp 1434-1442 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	atrial fibrillation atrial fibrillation type mortality registry stroke Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	atrial fibrillation atrial fibrillation type mortality registry stroke Diseases of the circulatory (Cardiovascular) system RC666-701 Sirin Apiyasawat Sakaorat Kornbongkotmas Ply Chichareon Rungroj Krittayaphong for the COOL‐AF Investigators Mortality risk and temporal patterns of atrial fibrillation in the nationwide registry
description	Abstract Aims Persistent and permanent atrial fibrillation (AF) often occurs in the presence of multiple comorbidities and is linked to adverse outcomes. It is unclear whether the sustained pattern of AF itself is prognostic or if it is confounded by underlying comorbidities. Here, we tested the association between the temporal patterns of AF and the risks of ischemic stroke and all‐cause mortality. Methods and Results In a prospective multicenter cohort, 3046 non‐valvular AF patients were consecutively enrolled and followed for adverse outcomes of all‐cause mortality and ischemic stroke. The risks of both outcomes were adjusted for underlying comorbidities, and compared between the patterns of AF. At baseline, the patients were classified as paroxysmal (N = 963, 31.6%), persistent (N = 604, 19.8%), and permanent AF (N = 1479, 45.6%) according to the standard definition. Anticoagulants were administered in 75% of all patients and 83% of those with CHA2DS2‐VASc score ≥2 in males or ≥3 in females. During a mean follow up of 26 (SD 10.5) months, all‐cause mortality occurred less in paroxysmal AF (2.5 per 100 patient‐years) than in persistent AF (4.4 per 100 patient‐years; adjusted hazard ratio [HR] 0.66, 95% CI, 0.46‐0.96; P = .029) and permanent AF (4.1 per 100 patient‐years; adjusted HR 0.71, 95% CI, 0.52‐0.98; P = .036). The risk of ischemic stroke was similar across all patterns of AF. Conclusions In this multicenter cohort of AF patients, persistent and permanent AF was associated with higher all‐cause mortality than paroxysmal AF, independent of baseline comorbidities. Clinical Trial Registration Thai Clinical Trial Registration; Study ID: TCTR20160113002 (http://www.thaiclinicaltrials.org/show/TCTR20160113002).
format	article
author	Sirin Apiyasawat Sakaorat Kornbongkotmas Ply Chichareon Rungroj Krittayaphong for the COOL‐AF Investigators
author_facet	Sirin Apiyasawat Sakaorat Kornbongkotmas Ply Chichareon Rungroj Krittayaphong for the COOL‐AF Investigators
author_sort	Sirin Apiyasawat
title	Mortality risk and temporal patterns of atrial fibrillation in the nationwide registry
title_short	Mortality risk and temporal patterns of atrial fibrillation in the nationwide registry
title_full	Mortality risk and temporal patterns of atrial fibrillation in the nationwide registry
title_fullStr	Mortality risk and temporal patterns of atrial fibrillation in the nationwide registry
title_full_unstemmed	Mortality risk and temporal patterns of atrial fibrillation in the nationwide registry
title_sort	mortality risk and temporal patterns of atrial fibrillation in the nationwide registry
publisher	Wiley
publishDate	2021
url	https://doaj.org/article/7fdc30e60c0843b19c9b4b99e9f7fca0
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Mortality risk and temporal patterns of atrial fibrillation in the nationwide registry

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