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Comparative thromboembolic risk in atrial fibrillation with and without a secondary precipitant-Danish nationwide
A Gundlund1, Thomas Kümler2, Anders Nissen Bonde2
1Department of Cardiology, Herlev and Gentofte Hospital, Hellerup, Denmark annagundlund@gmail.com.
Insights
Patients with atrial fibrillation (AF) and a secondary precipitant generally face the same long-term thromboembolic risk as those without. Further research is needed for optimal management strategies in this patient group.
Area of Science:
- Cardiology
- Internal Medicine
- Public Health
Background:
- Atrial fibrillation (AF) is a common arrhythmia with significant thromboembolic risk.
- Secondary precipitants can complicate AF management and potentially alter long-term outcomes.
- Understanding the impact of these precipitants is crucial for effective patient care.
Purpose of the Study:
- To compare the long-term outcomes of patients with atrial fibrillation (AF) who experienced a secondary precipitant versus those who did not.
- To identify specific secondary precipitants that may influence thromboembolic risk in AF patients.
- To inform clinical practice regarding the management of AF with secondary precipitants.
Main Methods:
- A retrospective cohort study utilizing Danish nationwide registries from 1996 to 2015.
- 1:1 matching of patients with AF and a secondary precipitant to those without, based on age, sex, CHA 2 DS2 -VASc score, and oral anticoagulation therapy (OAC).
- Multivariable Cox regression analysis to examine long-term risks of primary (thromboembolic events) and secondary (AF rehospitalisation, death) outcomes.
Main Results:
- The most frequent secondary precipitants were infection (55.0%), surgery (13.2%), and myocardial infarction (12.0%).
- The 5-year absolute risk of thromboembolic events varied by precipitant, ranging from 8.3% (alcohol intoxication) to 12.3% (no secondary precipitant).
- AF with a secondary precipitant was associated with similar or higher thromboembolic risk compared to AF without, with a notable exception for thyrotoxicosis patients not on OAC.
Conclusions:
- In general, atrial fibrillation with a secondary precipitant carries a similar thromboembolic risk to AF without a secondary precipitant.
- The findings underscore the need for further investigation into the long-term management of AF patients who experience secondary precipitants.
- Individualized management strategies may be required, particularly considering specific precipitants like thyrotoxicosis.
Objectives:
We compared long-term outcomes in patients with atrial fibrillation (AF) with and without a secondary precipitant.
Design And Setting:
Retrospective cohort study based on Danish nationwide registries.
Participants:
Patients with AF with and without secondary precipitants (1996-2015) were matched 1:1 according to age, sex, calendar year, CHA2DS2-VASc score and oral anticoagulation therapy (OAC), resulting in a cohort of 39 723 patients with AF with a secondary precipitant and the same number of patients with AF without a secondary precipitant. Secondary precipitants included alcohol intoxication, thyrotoxicosis, myocardial infarction, surgery and infection in conjunction with AF.
Primary And Secondary Outcomes:
The primary outcome in this study was thromboembolic events. Secondary outcomes included AF rehospitalisation and death. Long-term risks of outcomes were examined by multivariable Cox regression analysis.
Results:
The most common precipitants were infection (55.0%), surgery (13.2%) and myocardial infarction (12.0%). The 5-year absolute risk of thromboembolic events (taking death into account as a competing risk) in patients with AF grouped according to secondary precipitants were 8.3% (alcohol intoxication), 8.5% (thyrotoxicosis), 12.1% (myocardial infarction), 11.6% (surgery), 12.2% (infection), 10.1% (>1 precipitant) and 12.3% (no secondary precipitant). In the multivariable analyses, AF with a secondary precipitant was associated with the same or an even higher thromboembolic risk than AF without a secondary precipitant. One exception was patients with AF and thyrotoxicosis: those not initiated on OAC therapy carried a lower thromboembolic risk the first year of follow-up than matched patients with AF without a secondary precipitant and no OAC therapy.
Conclusions:
In general, AF with a secondary precipitant was associated with the same thromboembolic risk as AF without a secondary precipitant. Consequently, this study highlights the need for more research regarding the long-term management of patients with AF associated with a secondary precipitant.