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Published on: February 26, 2013
Different Implications of Heart Failure, Ischemic Stroke, and Mortality Between Nonvalvular Atrial Fibrillation and
Yu-Sheng Lin1,2, Tien-Hsing Chen3, Ching-Chi Chi4,5
1Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan.
Insights
Atrial fibrillation (AF) patients experienced higher rates of ischemic stroke, heart failure hospitalization, and all-cause mortality compared to atrial flutter (AFL) patients. These differences persisted even after matching for comorbidities and other factors.
Area of Science:
- Cardiology
- Electrophysiology
- Public Health
Background:
- Atrial flutter (AFL) and atrial fibrillation (AF) share similarities in stroke risk but differ in electrophysiological mechanisms.
- Previous understanding suggested equivalent stroke prevention, necessitating further investigation into clinical outcomes.
Purpose of the Study:
- To compare clinical outcomes, including ischemic stroke, heart failure hospitalization, and all-cause mortality, between patients with nonvalvular AF and AFL.
- To elucidate prognostic differences in real-world settings and after statistical adjustment.
Main Methods:
- A 13-year national cohort study comparing 175,420 AF patients with 6,239 AFL patients.
- Analysis included real-world data and propensity score matching to control for confounding factors.
- Outcomes assessed were ischemic stroke, heart failure hospitalization, and all-cause mortality.
Main Results:
- AF patients had higher prevalence of comorbidities and medication use than AFL patients.
- In real-world data, AF patients showed significantly higher rates of ischemic stroke, heart failure hospitalization, and all-cause mortality (P<0.001).
- Post-propensity score matching, AF patients had a 1.63-fold higher risk of ischemic stroke, 1.70-fold higher risk of heart failure hospitalization, and 1.08-fold higher risk of all-cause mortality compared to AFL patients.
Conclusions:
- Significant differences exist in comorbidities and prognosis between AF and AFL.
- AF is associated with a worse prognosis regarding ischemic stroke, heart failure hospitalization, and all-cause mortality compared to AFL.
Background:
Atrial flutter (AFL) has been identified to be equivalent to atrial fibrillation (AF) in terms of preventing ischemic stroke, although differences exist in atrial rate, substrate, and electrophysiological mechanisms. This study aimed to investigate differences in clinical outcomes between nonvalvular AF and AFL.
Methods And Results:
AF and AFL patients without any prescribed anticoagulation were enrolled from a 13-year national cohort database. Under series exclusion criteria, ischemic stroke, heart failure hospitalization, and all-cause mortality were compared between the groups in real-world conditions and after propensity score matching. We identified 175 420 patients in the AF cohort and 6239 patients in the AFL cohort, and the prevalence of most comorbidities and frequency of medications were significantly higher in the AF group than the AFL group. In the real-world setting the AF patients had higher incidence rates of ischemic stroke, heart failure hospitalization, and all-cause mortality than the AFL patients (all P<0.001). After propensity score matching, the incidence rate of ischemic stroke in the AF cohort was 1.63-fold higher than in the AFL cohort (P<0.001), the incidence rate of heart failure hospitalization in the AF cohort was 1.70-fold higher than in the AFL cohort (P<0.001), and the incidence rate of all-cause mortality in the AF cohort was 1.08-fold higher than in the AFL cohort (P=0.002).
Conclusions:
There were differences between AF and AFL in comorbidities and prognosis with regard to ischemic stroke, heart failure hospitalization, and all-cause mortality.
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