Impact of Atrial Fibrillation on Survival in Adults with Congenital Heart Disease: a Retrospective Population-based Study

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Adults with congenital heart disease (ACHD) (n=66690). Intervention: Atrial fibrillation vs. No atrial fibrillation. Primary outcome: All-cause death (HR 1.39, 95% CI 1.29-1.50, p=<0.001).

Shin Yi Jang; June Huh; Eun Kyoung Kim; Sung‐A Chang; Jinyoung Song; I‐Seok Kang; Seung Woo Park

doi:10.3346/jkms.2021.36.e43

January 1, 2021Journal of Korean Medical ScienceOpen Access

Impact of Atrial Fibrillation on Survival in Adults with Congenital Heart Disease: a Retrospective Population-based Study

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Key result

Atrial fibrillation in adults with congenital heart disease was associated with a significantly increased risk of death (adjusted HR 1.39) compared to those without atrial fibrillation.

Figures

Graphical abstract published by Journal of Korean Medical Science — Graphical abstract · Published by Journal of Korean Medical Science · CC BY-NC

Why the study?

The number of adults with congenital heart disease with atrial fibrillation is expected to increase, prompting assessment of the impact of atrial fibrillation on survival in Korean adults with congenital heart disease.

Does atrial fibrillation increase mortality in adults with congenital heart disease?

Study Design

Type

Cohort (n=66,690)

Multicenter

Yes

Structured PICO

Does atrial fibrillation increase mortality in adults with congenital heart disease?

P

Population

66,690 adults with congenital heart disease (ACHD) in Korea, mean age 48.9 years, 43.9% male.

I

Intervention

Atrial fibrillation (AF)

C

Comparator

No atrial fibrillation

O

Outcome

Death (survival rate and hazard ratio)hard clinical

Main Result

Effect estimate: HR 1.39 (95% CI 1.29-1.50)

Absolute Event Rate: 20.9% vs 8.3%

p-value: p=<0.001

Atrial fibrillation is common in adults with congenital heart disease and is independently associated with a significantly increased risk of mortality.

Limitations

National health insurance records might have missed ACHD patients who did not use medical services or paid out-of-pocket.
Lack of clinical data such as size of atrial shunt, timing of ASD repair, type of ASD, medication data, or occurrence of AF related to cardiac surgery.
Inability to determine the specific cause of death from the database.

Implication

AF in adults with congenital heart disease merits clinical attention; extends observational data but leaves causal and therapeutic questions open.

Abstract

BACKGROUND: The number of adults with congenital heart disease (ACHD) with atrial fibrillation (AF) is expected to increase. We sought to assess the impact of AF on survival in Korean ACHD. METHODS: Records of AF in ACHD were extracted from the records of the Korea National Health Insurance Service from 2006 through 2015. Multiple Cox proportional hazards analyses were carried out after adjustment for age, sex, income level, AF, and comorbidities. Survival rates (SRs) with and without AF were compared. The death records from 2006 through 2016 were included. RESULTS: < 0.001). CONCLUSION: In ACHD, AF occurs more frequently and has a worse prognosis than seen in the non-valvular general population in Korea. AF is associated with increased death in ACHD, especially with aging.

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Cite This Study

Jang et al. (2021) conducted a cohort in Adults with congenital heart disease (ACHD) (n=66,690). Atrial fibrillation vs. No atrial fibrillation was evaluated on All-cause death (HR 1.39, 95% CI 1.29-1.50, p=<0.001). Atrial fibrillation in adults with congenital heart disease was associated with a significantly increased risk of death (adjusted HR 1.39) compared to those without atrial fibrillation.

synapsesocial.com/papers/6a1c55794ebd09f3dfa9b820 https://doi.org/10.3346/jkms.2021.36.e43