Patients without comorbidities at the time of diagnosis of atrial fibrillation: causes of death during long-term follow-up compared to matched controls

Age threshold for anticoagulation in patients with atrial fibrillation: A Swedish nationwide observational study

BACKGROUND

There is controversy as to whether patients with atrial fibrillation (AF) and perceived low risk of cerebral infarction should be treated with anticoagulants, especially at what age a cut-off treatment might be indicated.

METHOD

We performed a retrospective, nationwide cohort study based on the Swedish National Patient Register and the Prescribed Drugs Register. Patients with a diagnosis of AF between July 1, 2005, and December 31, 2014, were included and divided into age categories (<55, 55-59, 60-64 and 65-74 years) and CHA₂DS₂-VA score of 0 and 1. Incidence rates (IR) of cerebral infarction and cerebral bleeding were calculated. Associations between outcomes from anticoagulant therapy and no therapy were calculated with Cox regression and given as hazard ratios (HR) with 95% confidence intervals (CI).

RESULTS

The analyzed cohort consisted of 294,470 patients. All age categories older than 55 years on anticoagulants had lower IR and HR for cerebral infarction compared to patients off anticoagulants, from HR 0.72, 95% CI (0.54-0.96) for patients 55-59 years with 0 points according to the CHA₂DS₂-VA score, to HR 0.37, 95% CI (0.33-0.42) for patients 65-74 years with 1 point. Anticoagulant therapy was associated to an increased risk of cerebral bleeding in three of seven categories, <55 years with 0 point, 55-59 years with 1 point, and 65-74 years with 1 point.

CONCLUSION

Anticoagulant therapy in patients with AF and age 55 years and older may be considered even if the patient has no other known risk factors for cerebral infarction.

Occupational Quartz Exposure in a Population of Male Individuals-Association With Risk of Developing Atrial Fibrillation

OBJECTIVE

Occupational quartz exposure is a health risk, with increased risk of developing lung, autoimmune diseases, and elevated mortality in cardiovascular diseases.

METHODS

The population was obtained from the period 2005 to 2016 and consisted of 5237 cases of patients with atrial fibrillation (AF). Quartz exposure information was obtained through a Swedish job exposure matrix.

RESULTS

The risk of developing AF was increased for the quartz-exposed male population who were within a year of having commenced employment OR 1.54; (95% CI 1.06-2.24); this increased in the age group 20 to 55 (OR 2.05; CI 95% 1.02-4.10).

CONCLUSION

Our main conclusion is that quartz dust exposure may be related to increased risk of AF in high exposed (above 0.05 mg/m mean quartz dust) in men aged 20 to 55 years.

Interaction of atrial fibrillation and antithrombotics on outcome in intracerebral hemorrhage

OBJECTIVE

To analyze the clinical differences between patients with primary intracerebral hemorrhage (ICH) with and without atrial fibrillation (AF) and assess whether the effect of the antithrombotic pretreatment on outcome is modified by the presence of AF.

METHODS

In this prospective observational study, researchers from 2 university hospitals included 1,106 consecutive patients with ICH. Clinical characteristics were described and stratified by presence of AF. In-hospital and 3-month mortality and 3-month disability were analyzed, considering antithrombotic pretreatment (none, antiplatelets, or oral anticoagulants) and AF (yes/no).

RESULTS

AF was present in 21.9% of primary ICH cases. Patients with AF-ICH were older, with more vascular risk factors, more antithrombotic pretreatment, higher clinical severity, higher hematoma volume, and higher in-hospital and 3-month mortality. Do-not-resuscitate orders were applied more frequently in AF-ICH cases. After 2 different adjustment models, mortality remained significantly higher in patients with AF-ICH. However, after introducing previous antithrombotic treatment in the model, the adjusted odds ratio for 3-month mortality was 1.45 (95% confidence interval 0.74-2.85, p = 0.284) for patients with AF-ICH compared with non-AF cases. AF modified the effect of antithrombotic pretreatment on in-hospital (p _int = 0.077) and 3-month mortality (p _int = 0.008). Among patients without AF, antithrombotic pretreatment increased mortality; no effect was observed in patients with AF-ICH.

CONCLUSIONS

Patients with AF and ICH had increased mortality; however, AF had no independent effect on mortality after adjustment for antithrombotic pretreatment. Conversely, antithrombotic pretreatment had a deleterious effect on outcome in patients with ICH without AF, but no detectable effect in patients with AF with ICH.

Patients without comorbidities at the time of diagnosis of atrial fibrillation: causes of death during long-term follow-up compared to matched controls

BACKGROUND

Little is known about the long-term, cause-specific mortality risk in patients without comorbidities at the time of diagnosis of atrial fibrillation (AF).

METHODS

From a nation-wide registry of patients hospitalized with incident AF between 1995 and 2008 we identified 9 519 patients with a first diagnosed AF and no comorbidities at the time of AF diagnosis. They were matched with 12 468 controls. The follow-up continued until December 2008. Causes of death were classified according to the ICD-10 codes.

RESULTS

During follow-up, 11.1% of patients with AF and 8.3% of controls died. Cardiovascular diseases were the most common causes of death and the only diagnoses which showed significantly higher relative risk in patients with AF than controls (HR 2.0, 95% CI 1.8-2.3), and the relative risk was significantly higher in women than in men. Stroke was a more common cause among patients with AF, 13.1% versus 9.7% (HR 2.7, 95% CI 1.8-4.0), while cerebral hemorrhage was more common among controls, 4.7% versus 10.2% (HR 0.9, 95% CI 0.6-1.5). The time from AF diagnosis to death was 6.0 ± 3.1 years.

CONCLUSIONS

In patients with incident AF and no known comorbidities at the time of AF diagnosis, only cardiovascular diseases were more often causes of death as compared to controls. Women carried a significantly higher relative risk than men.