Key result
Participants categorized as long-standing persistent atrial fibrillation showed poorer trajectories of cardiovascular risk factors prior to diagnosis compared to other AF patterns.
Why the study?
Clinical guidelines classify AF based on event temporality and duration, which is not applicable to population-based cohort settings.
Do longitudinal trajectories of cardiovascular risk factors differ prior to the development of specific atrial fibrillation patterns in men and women?
Cohort (n=14,061)
No
Do longitudinal trajectories of cardiovascular risk factors differ prior to the development of specific atrial fibrillation patterns in men and women?
Long-standing persistent atrial fibrillation is preceded by worse cardiovascular risk factor trajectories compared to single or multiple AF episodes, with notable sex differences in these preceding risk profiles.
BACKGROUND: Clinical guidelines categorize atrial fibrillation (AF) based on the temporality of AF events. Due to its dependence on event duration, this classification is not applicable to population-based cohort settings. We aimed to develop a simple and standardized method to classify AF patterns at population level. Additionally, we compared the longitudinal trajectories of cardiovascular risk factors preceding the AF patterns, and between men and women. METHODS: Between 1990 and 2014, participants from the population-based Rotterdam study were followed for AF status, and categorized into 'single-documented AF episode', 'multiple-documented AF episodes', or 'long-standing persistent AF'. Using repeated measurements we created linear mixed-effects models to assess the longitudinal evolution of risk factors prior to AF diagnosis. RESULTS: We included 14,061 participants (59.1% women, mean age 65.4 ± 10.2 years). After a median follow-up of 9.4 years (interquartile range 8.27), 1,137 (8.1%) participants were categorized as 'single-documented AF episode', 208 (1.5%) as 'multiple-documented AF episodes', and 57 (0.4%) as 'long-standing persistent AF'. In men, we found poorer trajectories of weight and waist circumference preceding 'long-standing persistent AF' as compared to the other patterns. In women, we found worse trajectories of all risk factors between 'long-standing persistent AF' and the other patterns. CONCLUSION: We developed a standardized method to classify AF patterns in the general population. Participants categorized as 'long-standing persistent AF' showed poorer trajectories of cardiovascular risk factors prior to AF diagnosis, as compared to the other patterns. Our findings highlight sex differences in AF pathophysiology and provide insight into possible risk factors of AF patterns.
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Tilly et al. (2022) conducted a cohort in Atrial fibrillation (n=14,061). Atrial fibrillation patterns vs. No AF / Other AF patterns was evaluated on Longitudinal trajectories of cardiovascular risk factors prior to AF diagnosis. Participants categorized as long-standing persistent atrial fibrillation showed poorer trajectories of cardiovascular risk factors prior to diagnosis compared to other AF patterns.
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