Associations of Atrial Fibrillation Patterns With Mortality and Cardiovascular Events: Implications of the MISOAC-AF Trial

• Main Authors: Amalia Baroutidou MD (Author), Anastasios Kartas MD, MSc (Author), Athanasios Samaras MD (Author), Andreas S. Papazoglou MD (Author), Eleni Vrana MD (Author), Dimitrios V. Moysidis MD (Author), Evangelos Akrivos MSc (Author), Anastasios Papanastasiou MD, MSc (Author), Ioannis Vouloagkas MD (Author), Michail Botis MD (Author), Evangelos Liampas MD (Author), Artemios G. Karagiannidis MD (Author), Efstratios Karagiannidis MD, PhD (Author), Georgios Efthimiadis MD, PhD (Author), Haralambos Karvounis MD, PhD (Author), Apostolos Tzikas MD, PhD (Author), George Giannakoulas MD, PhD (Author)
• Format: Book
• Published: SAGE Publishing, 2022-01-01T00:00:00Z.
• Subjects: article
• Online Access: Connect to this object online.

Summary

Aim: This retrospective cohort study aimed to evaluate the prognostic implications of the distinct atrial fibrillation (AF) temporal patterns: first diagnosed, paroxysmal, and persistent or permanent AF. Methods: In this post hoc analysis of the MISOAC-AF trial (NCT02941978), a total of 1052 patients with AF (median age 76 years), discharged from the cardiology ward between 2015 and 2018, were analyzed. Kaplan-Meier and Cox-regression analyses were performed to compare the primary outcome of all-cause mortality, the secondary outcomes of stroke, major bleeding and the composite outcome of cardiovascular (CV) mortality or hospitalization among AF patterns. Results: Of patients, 121 (11.2%) had first diagnosed, 356 (33%) paroxysmal, and 575 (53.2%) persistent or permanent AF. During a median follow-up of 31 months (interquartile range 10 to 52 months), 37.3% of patients died. Compared with paroxysmal AF, patients with persistent or permanent AF had higher mortality rates (adjusted hazard ratio (aHR), 1.37; 95% confidence interval [CI], 1.08-1.74, P = .009), but similar CV mortality or hospitalization rates (aHR, 1.09; 95% CI, 0.91-1.31, P = .35). Compared with first diagnosed AF, patients with persistent or permanent AF had similar mortality (aHR, 1.26; 95% CI, 0.87-1.82, P = .24), but higher CV mortality or hospitalization rates (aHR, 1.35; 95% CI, 1.01-1.8, P = .04). Stroke and major bleeding events did not differ across AF patterns (all P > .05). Conclusions: In conclusion, in recently hospitalized patients with comorbid AF, the presence of persistent or permanent AF was associated with a higher incidence of mortality and morbidity compared with paroxysmal and first diagnosed AF.

Item Description

1940-4034
10.1177/10742484211069422