Atrial Fibrillation Subtypes: Comparing Mortality Risks

Persistent atrial fibrillation (AF) compared with paroxysmal AF is independently associated with a higher risk for mortality in patients with nonvalvular AF, according to an analysis published in JACC: Clinical Electrophysiology.

Investigators assessed the implications associated with persistent or paroxysmal AF at first diagnosis for predicting the risk for long-term mortality. A total of 1773 patients with nonvalvular AF, of whom 1005 had persistent AF, were included in the 7-year analysis. The investigators obtained information regarding patient comorbidities, cardiovascular risk factors, and CHA₂DS₂-VASc scores.

Approximately 10% (n=80) of patients with paroxysmal AF died during the study vs 17% (n=174) of patients with persistent AF (P <.001). At first diagnosis of AF, the investigators found that persistent AF was independently associated with higher mortality than paroxysmal AF (hazard ratio [HR], 1.24; 95% CI, 1.11-1.38). These findings were also independent of the patient’s CHA₂DS₂-VASc score. A multivariable analysis verified these findings, demonstrating that a higher risk for all-cause mortality was attributable to the persistent AF clinical subtype (HR, 2.19; 95% CI, 1.072-4.476; P =.032).

The use of a retrospective design represents a potential limitation with this study. Also, the investigators only assessed the prognostic implications of AF clinical subtypes at the initial diagnosis and did not examine whether associations existed between mortality risk and patients with longer disease durations.

In addition to using clinical subtypes of AF to predict outcomes, the investigators suggested that “examining the prognostic value of the CHA₂DS₂-VASc score in patients without AF” may be an important strategy for further risk stratification.

Reference

Leung M, van Rosendael PJ, Abou R, et al. The impact of atrial fibrillation clinical subtype on mortality [published online November 1, 2017]. JACC Clin Electrophysiol. doi:10.1016/j.jacep.2017.09.002