Key result
Atrial fibrillation without comorbidities was associated with a 73% higher risk of total cardiovascular events (HR 1.73) compared to age-, sex-, and cohort-matched individuals without atrial fibrillation.
Why the study?
Does atrial fibrillation without comorbidities confer a worse prognosis compared with matched individuals without AF or typical AF?
Cohort (n=10,311)
No
Does atrial fibrillation without comorbidities confer a worse prognosis compared with matched individuals without AF or typical AF?
Effect estimate: HR 1.73 (95% CI 1.39-2.16)
Absolute Event Rate: 94% vs 65%
p-value: p=<0.001
Atrial fibrillation without comorbidities ('lone AF') is not a benign condition, as it confers a significantly higher risk of mortality and cardiovascular events compared to individuals without AF, although the risk is lower than in typical AF.
Lone AF may warrant closer surveillance clinically; extends evidence it is not benign but leaves optimal management open for trials.
BACKGROUND: The epidemiology of atrial fibrillation (AF) without comorbidities, known as 'lone AF', is uncertain. Although it has been considered a benign condition, we hypothesized that it confers a worse prognosis compared with a matched sample without AF. METHODS: We described the proportion of AF without comorbidities (clinical, subclinical cardiovascular disease and triggers) among the entire AF sample in Framingham Heart Study (FHS). We compared AF without comorbidities with typical AF, and age-, sex- and cohort-matched individuals without AF, using Cox proportional hazards analysis in relation to combined cardiovascular events (stroke, heart failure, myocardial infarction), and mortality. RESULTS: Of 10,311 FHS participants, 1,961 were diagnosed with incident AF, among which 173 individuals had AF without comorbidities (47% women, mean age 71±12 years). AF without comorbidities had a prevalence of 1.7% of the entire cohort, and an annual incidence of 0.5 per 1000 person-years. During a median follow-up of 9.7 years after initial AF, 137 individuals with AF without comorbidities (79.2%) died and 141 individuals developed cardiovascular events (81.5%). AF without comorbidities had significantly lower mortality (HR 0.67, 95%CI 0.55-0.81, P < .001) and total cardiovascular events (HR 0.66, 95% CI 0.55-0.80, P < .001) compared with typical AF. However, mortality (HR1.43, 95% CI 1.18-1.75, P < .001) and risk of total cardiovascular events (HR 1.73, 95% CI 1.39-2.16, P < .001) were higher than age-, sex-, and cohort-matched individuals without AF. CONCLUSIONS: The risk of cardiovascular outcomes and mortality among individuals with AF without comorbidities is lower than typical AF, but is significantly elevated compared with matched individuals without AF.
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Kim et al. (2016) conducted a cohort in Atrial fibrillation without comorbidities (n=10,311). Atrial fibrillation without comorbidities vs. Age-, sex-, and cohort-matched individuals without atrial fibrillation was evaluated on Total cardiovascular events (stroke, heart failure, myocardial infarction) (HR 1.73, 95% CI 1.39-2.16, p=<0.001). Atrial fibrillation without comorbidities was associated with a 73% higher risk of total cardiovascular events (HR 1.73) compared to age-, sex-, and cohort-matched individuals without atrial fibrillation.
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