Incidence and outcome of atrial fibrillation in stable symptomatic coronary disease

OBJECTIVES: Evaluate the prevalence, incidence and impact on prognosis of existing and new onset atrial fibrillation (AF) in patients with stable, symptomatic coronary artery disease. DESIGN: Data from the 7 665 participants included in the ACTION (A Coronary disease Trial Investigating Outcome with Nifedipine GITS) trial was used. RESULTS: Over a mean follow-up of 4.9 years, the incidence of recurrent AF in patients with AF at baseline (4.1%) was 13.5/100 patient-years and 1.64/100 patient-years for patients without baseline AF. Patients with AF at baseline had increased mortality and new overt heart failure. New onset AF was associated with increased morbidity and mortality and in particular soon after onset. adjusted 30-day relative risk for mortality 23, 95% CI 14-36; for debilitating stroke 37, 95% CI 18-77; and for heart failure 54, 95% CI 32-93. The incidence of AF was not affected by treatment with nifedipine GITS. CONCLUSION: The presence of AF in patients with stable symptomatic CAD is an independent risk factor and in particular in the first 30 days for subsequent mortality and morbidity.