BMJ open · 2019
Comparative thromboembolic risk in atrial fibrillation with and without a secondary precipitant-Danish nationwide cohort study.
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Gundlund A, Kümler Thomas, Bonde Anders Nissen, Butt Jawad Haider, Gislason Gunnar Hilmar, Torp-Pedersen Christian, Køber Lars, Olesen Jonas Bjerring, Fosbøl Emil Loldrup
Аннотация
OBJECTIVES: We compared long-term outcomes in patients with atrial fibrillation (AF) with and without a secondary precipitant.
DESIGN AND SETTING: Retrospective cohort study based on Danish nationwide registries.
PARTICIPANTS: Patients with AF with and without secondary precipitants (1996-2015) were matched 1:1 according to age, sex, calendar year, CHA2DS2-VASc score and oral anticoagulation therapy (OAC), resulting in a cohort of 39 723 patients with AF with a secondary precipitant and the same number of patients with AF without a secondary precipitant. Secondary precipitants included alcohol intoxication, thyrotoxicosis, myocardial infarction, surgery and infection in conjunction with AF.
PRIMARY AND SECONDARY OUTCOMES: The primary outcome in this study was thromboembolic events. Secondary outcomes included AF rehospitalisation and death. Long-term risks of outcomes were examined by multivariable Cox regression analysis.
RESULTS: The most common precipitants were infection (55.0%), surgery (13.2%) and myocardial infarction (12.0%). The 5-year absolute risk of thromboembolic events (taking death into account as a competing risk) in patients with AF grouped according to secondary precipitants were 8.3% (alcohol intoxication), 8.5% (thyrotoxicosis), 12.1% (myocardial infarction), 11.6% (surgery), 12.2% (infection), 10.1% (>1 precipitant) and 12.3% (no secondary precipitant). In the multivariable analyses, AF with a secondary precipitant was associated with the same or an even higher thromboembolic risk than AF without a secondary precipitant. One exception was patients with AF and thyrotoxicosis: those not initiated on OAC therapy carried a lower thromboembolic risk the first year of follow-up than matched patients with AF without a secondary precipitant and no OAC therapy.
CONCLUSIONS: In general, AF with a secondary precipitant was associated with the same thromboembolic risk as AF without a secondary precipitant. Consequently, this study highlights the need for more research regarding the long-term management of patients with AF associated with a secondary precipitant.
DESIGN AND SETTING: Retrospective cohort study based on Danish nationwide registries.
PARTICIPANTS: Patients with AF with and without secondary precipitants (1996-2015) were matched 1:1 according to age, sex, calendar year, CHA2DS2-VASc score and oral anticoagulation therapy (OAC), resulting in a cohort of 39 723 patients with AF with a secondary precipitant and the same number of patients with AF without a secondary precipitant. Secondary precipitants included alcohol intoxication, thyrotoxicosis, myocardial infarction, surgery and infection in conjunction with AF.
PRIMARY AND SECONDARY OUTCOMES: The primary outcome in this study was thromboembolic events. Secondary outcomes included AF rehospitalisation and death. Long-term risks of outcomes were examined by multivariable Cox regression analysis.
RESULTS: The most common precipitants were infection (55.0%), surgery (13.2%) and myocardial infarction (12.0%). The 5-year absolute risk of thromboembolic events (taking death into account as a competing risk) in patients with AF grouped according to secondary precipitants were 8.3% (alcohol intoxication), 8.5% (thyrotoxicosis), 12.1% (myocardial infarction), 11.6% (surgery), 12.2% (infection), 10.1% (>1 precipitant) and 12.3% (no secondary precipitant). In the multivariable analyses, AF with a secondary precipitant was associated with the same or an even higher thromboembolic risk than AF without a secondary precipitant. One exception was patients with AF and thyrotoxicosis: those not initiated on OAC therapy carried a lower thromboembolic risk the first year of follow-up than matched patients with AF without a secondary precipitant and no OAC therapy.
CONCLUSIONS: In general, AF with a secondary precipitant was associated with the same thromboembolic risk as AF without a secondary precipitant. Consequently, this study highlights the need for more research regarding the long-term management of patients with AF associated with a secondary precipitant.
Предметные рубрики MeSH
AgedAged, 80 and overAlcoholic IntoxicationAnticoagulantsAtrial FibrillationDenmarkFemaleHumansInfectionsMaleMiddle AgedMyocardial InfarctionPostoperative ComplicationsPractice Guidelines as TopicPrognosisProportional Hazards ModelsRecurrenceRegistriesRetrospective StudiesThromboembolismThyrotoxicosisTreatment Outcome