The AFLETES Study: Atrial Fibrillation in Veteran Athletes and the Risk of Stroke

Abstract

Objectives: Endurance athletes are at an increased risk of atrial fibrillation (AF) when compared with the general population. However, the risk of stroke in athletes with AF is unknown. Design and Setting: We aimed to assess this risk using an international online survey. Patients: Individuals that had competed in ≥1 competitive events and were ≥40 years old were included. Interventions: Self-reported demographic, medical history, and training history data were collected, and a CHA2DS2-VASc was calculated. Main Outcome Measures: Binary logistic regression was used to assess variables associated with AF and stroke. Results: There were 1002 responses from participants in 41 countries across Africa, Asia, Australasia, Europe, and North and South America, and 942 were included in the final analysis. The average age was 52.4 ± 8.5 years, and 84% were male. The most common sports were cycling (n = 677, 72%), running (n = 558, 59%), and triathlon (n = 245, 26%). There were 190 (20%) individuals who reported AF and 26 individuals (3%) who reported stroke; of which, 14 (54%) had AF. Lifetime exercise dose [odds ratio (OR), 1.02, 95% confidence interval (95% CI),1.00-1.03, P = 0.02] and swimming (OR, 1.56, 95% CI, 1.02-2.39, P = 0.04) were associated with AF in multivariable analysis, independent of other risk factors. Atrial fibrillation was associated with stroke (OR, 4.18, 95% CI, 1.80-9.72, P < 0.01), even in individuals with a low (0/1) CHA2DS2-VASc score (OR, 4.20, 95% CI, 1.83-9.66, P < 0.01). Conclusions: This survey provides early evidence that veteran endurance athletes who develop AF may be at an increased risk of developing stroke, even in those deemed to be at low risk by CHA2DS2-VASc score.