Risk of cardiovascular and cerebrovascular events after atrial fibrillation diagnosis☆

Abstract 

Background

Atrial fibrillation (AF) is associated with subsequent cardiovascular events including ischemic stroke, transient ischemic events, and coronary events. This study aimed to evaluate the risk of ischemic cerebrovascular events (ICVE), coronary events (CE) or heart failure (HF) following a diagnosis of AF.

Methods

Patients were selected from the UK General Practice Research Database. The incidence of ICVE, CE and HF was determined during a 6-year follow-up period for patients with a first diagnosis of AF (n=831) and a control group without AF (n=8226). Relative risk of developing a cardiovascular event associated with prior AF and other potential risk factors was estimated using Cox regression analysis.

Results

A first diagnosis of ICVE, CE or HF was made in 261 patients in the AF group and 622 in the control group. The relative risks associated with AF were 2.1 for CE (95% CI: 1.6–2.9), 3.0 for ICVE (95% CI: 2.3–4.0) and 6.4 for HF (95% CI: 5.0–8.3). The risks of CE, HF and ICVE were higher in patients with chronic AF than paroxysmal AF (odds ratio: 1.5, 95% CI: 1.0–2.2) and in patients aged at least 60 years or with diabetes. Lifestyle factors did not significantly affect the risk of cardiovascular events in patients with AF.

Conclusions

After a first episode of AF there is an increased risk of ICVE, CE and HF. Patients initially diagnosed with chronic AF have a higher risk than those with paroxysmal AF.

Keywords: Atrial fibrillation, Ischemic cerebrovascular accident, Heart failure, Coronary event, Epidemiology, Primary health care