Clinical Characteristics and Outcomes of First Diagnosed Atrial Fibrillation: Insights from Two Prospective Registries in Europe and Asia

Clinical characteristics and outcomes in patients with atrial fibrillation (AF) vary from diagnosis to advanced stages. To assess differences in characteristics and outcomes between patients with first diagnosed AF and known AF. A post hoc analysis of 2 prospective registries from Europe and Asia. The primary outcome was a composite of all-cause death and major adverse cardiovascular events, including thromboembolic events, cardiovascular death, acute coronary syndromes. Among 15,762 patients with AF, those with first diagnosed AF (n = 2081, age 68 ± 12 years, 41% women) were younger, more often women, with lower cardiovascular burden but higher prevalence of obesity, smoking, cancer. After a median follow-up of 693 days (interquartile range 365-735), first diagnosed AF was associated with a higher risk of the composite outcome (hazard ratio [HR] 1.311, 95% confidence interval [CI] 1.115-1.543), all-cause death (HR 1.389, 95% CI 1.153-1.673), major adverse cardiovascular events (HR 1.269, 95% CI 1.022-1.575), thromboembolic events (HR 1.495, 95% CI 1.043-2.145). Risk of the composite outcome in first diagnosed patients with AF was higher in late follow-up phase compared with early phase and among those enrolled in hospital settings than in outpatient settings. Patients with first diagnosed AF had a composite outcome risk similar to those with permanent AF (HR 0.921, 95% CI 0.771-1.101), but higher than those with paroxysmal (HR 0.650, 95% CI 0.535-0.790) and persistent AF (HR 0.676, 95% CI 0.554-0.826). A rhythm control strategy was associated with better outcomes than rate control. The higher risk of first diagnosed patients with AF underscores the need for personalized, integrated management strategies that consider the heterogeneity of this arrhythmia to improve outcomes.