August 3, 2026Journal of the American College of Cardiology293 citationsOpen Access
Incidence of Atrial Fibrillation and Relationship With Cardiovascular Events, Heart Failure, and Mortality
Key Result
Incident atrial fibrillation was significantly associated with an increased risk of cardiovascular events (HR 2.24), heart failure (HR 4.52), and all-cause mortality (HR 3.02).
Key Points
- The aim is to understand the incidence of atrial fibrillation and its relationship with cardiovascular outcomes and comorbidities in a contemporary cohort.
- Investigated the incidence of atrial fibrillation in a contemporary cohort in the Netherlands.
- Analyzed comorbidities associated with atrial fibrillation and cardiovascular outcomes.
- Documented incidence rates of atrial fibrillation in contemporary populations.
- Established significant associations between atrial fibrillation and cardiovascular events, heart failure, and mortality.
Study Design
Type
Cohort (n=8,265)
Multicenter
No
PICO
P
Population
8,265 community-dwelling adults aged 28 to 75 years from the Netherlands, free of prevalent atrial fibrillation at baseline, followed for a mean of 9.7 years.
E
Exposure / Comparator
Incident Atrial Fibrillation vs No Atrial Fibrillation
O
Primary Outcome
Cardiovascular events — HR 2.24 (1.06 to 4.75), p=0.035
Main Result
Hazard Ratio: 2.24 (95% CI 1.06–4.75)
Absolute Event Rate: 20.59% vs 10.13%
p-value: p=0.035
Limitations
- Observational design
- May have overlooked asymptomatic paroxysmal AF because of no continuous ECG recordings
- Cardiovascular event attributed to AF only when AF was diagnosed before the event, potentially underestimating event rates
- Stroke was defined using ICD codes without direct evaluation
- Data on obstructive sleep apnea were not available
- Treatment was left to the discretion of the physician
Abstract
BACKGROUND Important improvements have been made in treatment of diseases associated with atrial fibrillation (AF), such as hypertension, myocardial infarction, and heart failure. Incidence rates and risk factors may have changed with the aging of the population and changing lifestyles. Currently, the risk for AF is only partially explained, possibly because of differences between older cohorts and contemporary populations. OBJECTIVES This study investigated the incidence of AF in a contemporary cohort in the Netherlands, together with comorbidities associated with AF and associations of AF with cardiovascular outcomes.
Expert Takes1 quote
“Atrial fibrillation (AF) is associated with multiple comorbidities. AF is associated with cardiovascular events, stroke, heart failure, and all-cause mortality. The present study investigated the incidence of AF in a contemporary cohort in the Netherlands, the association of comorbidities with AF, and the association of AF with cardiovascular events, heart failure, and all-cause mortality. The study included 8265 persons in the PREVEND study. AF developed during 9.7 years of follow-up in 265 persons (3.3%). The mean age was 62 years in those who developed AF and 49 years in those who did not develop AF (p<0.001). Increasing age, male gender, antihypertensive drug use, higher body mass index, prior myocardial infarction, and prior stroke were associated with AF. AF was associated with cardiovascular events (hazard ratio =2.24; p=0.035), heart failure with either reduced or preserved ejection fraction (hazard ratio =4.52; p<0.001), and all-cause mortality (hazard ratio =3.02; p<0.001).”