Key result
Incident atrial fibrillation occurred in 4.7% of CAD outpatients over 3 years and was a powerful predictor of all-cause mortality (adjusted HR 2.04; 95% CI 1.47-2.83; p<0.0001).
Why the study?
The risk, correlates, and consequences of incident atrial fibrillation in patients with chronic coronary artery disease were largely unknown.
Does incident atrial fibrillation increase mortality in outpatients with chronic coronary artery disease?
Cohort (n=5,031)
Yes
Does incident atrial fibrillation increase mortality in outpatients with chronic coronary artery disease?
Hazard Ratio: 2.04 (95% CI 1.47–2.83)
p-value: p=< 0.0001
Incident atrial fibrillation in outpatients with chronic coronary artery disease occurs at a rate of 1.6% annually and is associated with a twofold increased risk of all-cause mortality.
Background: The risk, correlates, and consequences of incident atrial fibrillation (AF) in patients with chronic coronary artery disease (CAD) are largely unknown. Methods and results: We analyzed incident AF during a 3-year follow-up in 5031 CAD outpatients included in the prospective multicenter CARDIONOR registry and with no history of AF at baseline. Incident AF occurred in 266 patients (3-year cumulative incidence: 4.7% (95% confidence interval (CI): 4.1 to 5.3)). Incident AF was diagnosed during cardiology outpatient visits in 177 (66.5%) patients, 87 of whom were asymptomatic. Of note, 46 (17.3%) patients were diagnosed at time of hospitalization for heart failure, and a few patients (n = 5) at the time of ischemic stroke. Five variables were independently associated with incident AF: older age (p < 0.0001), heart failure (p = 0.003), lower left ventricle ejection fraction (p = 0.008), history of hypertension (p = 0.010), and diabetes mellitus (p = 0.033). Anticoagulant therapy was used in 245 (92%) patients and was associated with an antiplatelet drug in half (n = 122). Incident AF was a powerful predictor of all-cause (adjusted hazard ratio: 2.04; 95% CI: 1.47 to 2.83; p < 0.0001) and cardiovascular mortality (adjusted hazard ratio: 2.88; 95% CI: 1.88 to 4.43; p < 0.0001). Conclusions: In CAD outpatients, real-life incident AF occurs at a stable rate of 1.6% annually and is frequently diagnosed in asymptomatic patients during cardiology outpatient visits. Anticoagulation is used in most cases, often combined with antiplatelet therapy. Incident AF is associated with increased mortality.
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Ninni et al. (2020) conducted a cohort in chronic coronary artery disease (CAD) (n=5,031). Incident atrial fibrillation vs. No incident atrial fibrillation was evaluated on all-cause mortality (HR 2.04, 95% CI 1.47 to 2.83, p=< 0.0001). Incident atrial fibrillation occurred in 4.7% of CAD outpatients over 3 years and was a powerful predictor of all-cause mortality (adjusted HR 2.04; 95% CI 1.47-2.83; p<0.0001).
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