Author:
Blum Steffen,Aeschbacher Stefanie,Coslovsky Michael,Meyre Pascal B.,Reddiess Philipp,Ammann Peter,Erne Paul,Moschovitis Giorgio,Di Valentino Marcello,Shah Dipen,Schläpfer Jürg,Müller Rahel,Beer Jürg H.,Kobza Richard,Bonati Leo H.,Moutzouri Elisavet,Rodondi Nicolas,Meyer-Zürn Christine,Kühne Michael,Sticherling Christian,Osswald Stefan,Conen David,Aeschbacher Stefanie,Auberson Chloé,Blum Steffen,Bonati Leo,Ceylan Selinda,Conen David,Evers-Doerpfeld Simone,Eken Ceylan,Girod Marc,Hennings Elisa,Herber Elena,Iten Vasco,Krisai Philipp,Lampart Maurin,Lischer Mirko,Meyer-Zürn Christine,Meyre Pascal,Monsch Andreas U.,Müller Christian,Paladini Rebecca E.,Springer Anne,Sticherling Christian,Szucs Thomas,Völlmin Gian,Osswald Stefan,Kühne Michael,Aujesky Drahomir,Fischer Urs,Fuhrer Juerg,Roten Laurent,Jung Simon,Mattle Heinrich,Netzer Seraina,Adam Luise,Aubert Carole Elodie,Feller Martin,Loewe Axel,Moutzouri Elisavet,Schneider Claudio,Flückiger Tanja,Groen Cindy,Ehrsam Lukas,Hellrigl Sven,Nuoffer Alexandra,Rakovic Damiana,Schwab Nathalie,Wenger Rylana,Saffari Tu Hanh Zarrabi,Rodondi Nicolas,Reichlin Tobias,Beynon Christopher,Dillier Roger,Deubelbeiss Michèle,Eberli Franz,Franzini Christine,Juchli Isabel,Liedtke Claudia,Murugiah Samira,Nadler Jacqueline,Obst Thayze,Roth Jasmin,Schlomowitsch Fiona,Schneider Xiaoye,Studerus Katrin,Tynan Noreen,Weishaupt Dominik,Müller Andreas,Fontana Simone,Friedli Corinne,Kuest Silke,Scheuch Karin,Hischier Denise,Bonetti Nicole,Grau Alexandra,Villinger Jonas,Laube Eva,Baumgartner Philipp,Filipovic Mark,Frick Marcel,Montrasio Giulia,Leuenberger Stefanie,Rutz Franziska,Beer Jürg-Hans,Auricchio Angelo,Anesini Adriana,Camporini Cristina,Conte Giulio,Caputo Maria Luce,Regoli Francois,Moccetti Tiziano,Brenner Roman,Altmann David,Gemperle Michaela,Ammann Peter,Firmann Mathieu,Foucras Sandrine,Rime Martine,Hayoz Daniel,Berte Benjamin,Justi Virgina,Kellner-Weldon Frauke,Mehmann Brigitta,Meier Sonja,Roth Myriam,Ruckli-Kaeppeli Andrea,Russi Ian,Schmidt Kai,Young Mabelle,Zbinden Melanie,Kobza Richard,Rigamonti Elia,Cereda Carlo,Cianfoni Alessandro,De Perna Maria Luisa,Frangi-Kultalahti Jane,Melchiorre Patrizia Assunta Mayer,Pin Anica,Terrot Tatiana,Vicari Luisa,Moschovitis Giorgio,Ehret Georg,Gallet Hervé,Guillermet Elise,Lazeyras Francois,Lovblad Karl-Olof,Perret Patrick,Tavel Philippe,Teres Cheryl,Shah Dipen,Lauriers Nathalie,Méan Marie,Salzmann Sandrine,Schläpfer Jürg,Porretta Alessandra Pia,Grêt Andrea,Novak Jan,Vitelli Sandra,Stephan Frank-Peter,Frangi-Kultalahti Jane,Gallino Augusto,Vicari Luisa,Di Valentino Marcello,Aebersold Helena,Foster Fabienne,Schwenkglenks Matthias,Würfel Jens,Altermatt Anna,Amann Michael,Düring Marco,Huber Petra,Ruberte Esther,Sinnecker Tim,Zuber Vanessa,Coslovsky Michael,Benkert Pascal,Dutilh Gilles,Markovic Milica,Neuschwander Pia,Simon Patrick,Schmid Ramun,
Abstract
AbstractSustained forms of atrial fibrillation (AF) may be associated with a higher risk of adverse outcomes, but few if any long-term studies took into account changes of AF type and co-morbidities over time. We prospectively followed 3843 AF patients and collected information on AF type and co-morbidities during yearly follow-ups. The primary outcome was a composite of stroke or systemic embolism (SE). Secondary outcomes included myocardial infarction, hospitalization for congestive heart failure (CHF), bleeding and all-cause mortality. Multivariable adjusted Cox proportional hazards models with time-varying covariates were used to compare hazard ratios (HR) according to AF type. At baseline 1895 (49%), 1046 (27%) and 902 (24%) patients had paroxysmal, persistent and permanent AF and 3234 (84%) were anticoagulated. After a median (IQR) follow-up of 3.0 (1.9; 4.2) years, the incidence of stroke/SE was 1.0 per 100 patient-years. The incidence of myocardial infarction, CHF, bleeding and all-cause mortality was 0.7, 3.0, 2.9 and 2.7 per 100 patient-years, respectively. The multivariable adjusted (a) HRs (95% confidence interval) for stroke/SE were 1.13 (0.69; 1.85) and 1.27 (0.83; 1.95) for time-updated persistent and permanent AF, respectively. The corresponding aHRs were 1.23 (0.89, 1.69) and 1.45 (1.12; 1.87) for all-cause mortality, 1.34 (1.00; 1.80) and 1.30 (1.01; 1.67) for CHF, 0.91 (0.48; 1.72) and 0.95 (0.56; 1.59) for myocardial infarction, and 0.89 (0.70; 1.14) and 1.00 (0.81; 1.24) for bleeding. In this large prospective cohort of AF patients, time-updated AF type was not associated with incident stroke/SE.
Funder
Mach-Gaensslen Foundation
Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung
Swiss Heart Foundation
Roche Diagnostics
Boehringer Ingelheim
Sanofi-Aventis
Merck Sharp&Dohme
Bayer
Daiichi-Sankyo
Pfizer/Bristol-Myers Squibb
Foundation for Cardiovascular Research Basel
Hamilton Health Sciences RFA Strategic Initiative Program
McMaster University Department of Medicine Mid-Career Research Award