Prognosis in patients with atrial fibrillation and a presumed "temporary cause" in a community-based cohort study

Atrial fibrillation (AF) may be related to acute and temporary causes, whether cardiovascular or non-cardiovascular. It remains unclear whether the risk of ischemic stroke is different in this setting, and whether antithrombotic management should be different in these patients. The objective of the study was to describe and compare the risk of stroke in AF patients with and with no such temporary precipitating cause.

Among 8962 patients with AF seen between 2000 and 2010, we focused our analysis on 4587 patients with non-permanent AF, of whom 740 (16 %) had at least one possible temporary cause of AF.

During a mean follow-up of 944 days (median 451, interquartile range 8-1624), the adjusted rates of stroke/TE were non-significantly different between patients with a temporary cause of AF and other AF patients (HR = 1.08, 95 % CI 0.82-1.41, p = 0.59 after adjustment on age, gender, CHA₂DS₂VASc score, OAC use and antiplatelet therapy use). Cardiovascular mortality was higher in patients with a temporary cause when compared to other AF patients (adjusted HR = 1.42, 95 % CI 1.08-1.86, p = 0.01). In patients with a temporary cause of AF, prescription of oral anticoagulation was independently associated with a better prognosis for cardiovascular death/stroke/thromboembolism (HR = 0.44, 95 % CI 0.29-0.67, p = 0.0001).

AF patients with presumed temporary cause of AF had a similar risk of stroke/thromboembolism and a worse prognosis for cardiovascular mortality than other AF patients. Use of oral anticoagulation was associated with a better prognosis in these patients.