Adverse prognosis of incidentally detected ambulatory atrial fibrillation

Carlos Martinez; Anja Katholing; Saul Benedict Freedman

doi:10.1160/TH4-04-0383

Thrombosis and Haemostasis, Inhaltsverzeichnis

Thromb Haemost 2014; 112(02): 276-286
DOI: 10.1160/TH4-04-0383

Blood Coagulation, Fibrinolysis and Cellular Haemostasis

Schattauer GmbH

Adverse prognosis of incidentally detected ambulatory atrial fibrillation

A cohort study

Authors

Carlos Martinez

¹Institute for Epidemiology, Statistics and Informatics GmbH, Frankfurt, Germany
Anja Katholing

¹Institute for Epidemiology, Statistics and Informatics GmbH, Frankfurt, Germany
Saul Benedict Freedman

²Department of Cardiology Concord Hospital and Anzac Research Institute, Sydney Medical School, University of Sydney, Australia

Abstract

Summary

It was the aim of this study to determine prognosis of incidentally detected ambulatory atrial fibrillation (IA-AF) and its response to antithrombotic therapy. We performed a cohort study of 5,555 patients with IA-AF (mean age 70.9 ± 10.1, 38.4% female) and 24,705 age- and gender-matched controls without AF followed three years using UK Clinical Practice Research Datalink. We measured incidence rates of stroke, all-cause mortality, myocardial infarction, major bleeding, and effect of antithrombotic therapy. Patients with IA-AF had mean CHA₂DS₂VASc score 2.5 ± 1.5, 73% with score ≥2. The stroke incidence rate (IR) was 19.4 (95% confidence interval 17.1 – 21.9)/1,000 person-years vs 8.4 (7.7 – 9.1) in controls (p<0.001), mortality 40.1 (36.8 – 43.6)/1,000 person-years vs 20.9 (19.8 – 22.0) in controls (p<0.001), and myocardial infarction 9.0 (7.5 – 10.8)/1,000 person-years vs 6.5 (5.9 – 7.2) in controls (p<0.001). IRs of all endpoints increased with age. Oral anticoagulant ± antiplatelet therapy received by 51.0% in year following IA-AF was associated with adjusted hazard ratio (HR) of 0.35 (0.17 – 0.71) for stroke, and 0.56 (0.36 – 0.85) for death compared to no therapy, while antiplatelet treatment was associated with a non-significant reduction of HR: 0.81 (0.51 – 1.29) for stroke, and 0.80 (0.55 – 1.15) for death, though both carried a similar small non-significant adjusted excess IR of major bleeding. In conclusion, asymptomatic AF detected incidentally is associated with a significant adverse effect on stroke and death, with reduction in both associated with oral anticoagulant but not antiplatelet treatment. This provides justification to assess cost-effectiveness of community screening to detect unknown AF.

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Referenzen

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