Key result
AF patients without traditional risk factors had lower 1-year stroke occurrence (0.6% vs 2.0%, P=0.013) and heart failure hospitalizations (0.9% vs 12.5%, P<0.001) compared to matched controls.
Why the study?
Data on patient characteristics, prevalence, and outcomes of AF patients without traditional risk factors, often labelled lone AF, are sparse.
What are the characteristics and outcomes of atrial fibrillation patients without traditional risk factors compared to those with traditional risk factors?
Observational (n=3,184)
Yes
What are the characteristics and outcomes of atrial fibrillation patients without traditional risk factors compared to those with traditional risk factors?
Almost all AF patients without traditional risk factors have less-established or borderline risk factors, and while they have a favorable 1-year prognosis for stroke and HF, their risk of AF-related re-hospitalization remains high.
Lower stroke/HF rates in AF without traditional factors may refine stratification; leaves open rehospitalization prevention and guideline applicability.
AIMS: Data on patient characteristics, prevalence, and outcomes of atrial fibrillation (AF) patients without traditional risk factors, often labelled 'lone AF', are sparse. METHODS AND RESULTS: The RE-LY AF registry included 15 400 individuals who presented to emergency departments with AF in 47 countries. This analysis focused on patients without traditional risk factors, including age ≥60 years, hypertension, coronary artery disease, heart failure, left ventricular hypertrophy, congenital heart disease, pulmonary disease, valve heart disease, hyperthyroidism, and prior cardiac surgery. Patients without traditional risk factors were compared with age- and region-matched controls with traditional risk factors (1:3 fashion). In 796 (5%) patients, no traditional risk factors were present. However, 98% (779/796) had less-established or borderline risk factors, including borderline hypertension (130-140/80-90 mmHg; 47%), chronic kidney disease (eGFR < 60 mL/min; 57%), obesity (body mass index > 30; 19%), diabetes (5%), excessive alcohol intake (>14 units/week; 4%), and smoking (25%). Compared with patients with traditional risk factors (n = 2388), patients without traditional risk factors were more often men (74% vs. 59%, P < 0.001) had paroxysmal AF (55% vs. 37%, P < 0.001) and less AF persistence after 1 year (21% vs. 49%, P < 0.001). Furthermore, 1-year stroke occurrence rate (0.6% vs. 2.0%, P = 0.013) and heart failure hospitalizations (0.9% vs. 12.5%, P < 0.001) were lower. However, risk of AF-related re-hospitalization was similar (18% vs. 21%, P = 0.09). CONCLUSION: Almost all patients without traditionally defined AF risk factors have less-established or borderline risk factors. These patients have a favourable 1-year prognosis, but risk of AF-related re-hospitalization remains high. Greater emphasis should be placed on recognition and management of less-established or borderline risk factors.
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Kloosterman et al. (2019) conducted an observational in Atrial fibrillation (n=3,184). Absence of traditional risk factors vs. Presence of traditional risk factors was evaluated on 1-year stroke occurrence rate (p=0.013). AF patients without traditional risk factors had lower 1-year stroke occurrence (0.6% vs 2.0%, P=0.013) and heart failure hospitalizations (0.9% vs 12.5%, P<0.001) compared to matched controls.
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