TY - JOUR
T1 - Comparative thromboembolic risk in atrial fibrillation with and without a secondary precipitant-Danish nationwide cohort study
AU - Gundlund, A
AU - Kümler, Thomas
AU - Bonde, Anders Nissen
AU - Butt, Jawad Haider
AU - Gislason, Gunnar Hilmar
AU - Torp-Pedersen, Christian
AU - Køber, Lars
AU - Olesen, Jonas Bjerring
AU - Fosbøl, Emil Loldrup
N1 - © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2019/9/20
Y1 - 2019/9/20
N2 - 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.
AB - 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.
KW - recurrence
KW - reversible atrial fibrillation
KW - secondary precipitant
UR - http://www.scopus.com/inward/record.url?scp=85072586477&partnerID=8YFLogxK
U2 - 10.1136/bmjopen-2018-028468
DO - 10.1136/bmjopen-2018-028468
M3 - Journal article
C2 - 31542739
SN - 2044-6055
VL - 9
JO - BMJ Open
JF - BMJ Open
IS - 9
M1 - e028468
ER -