Prevalence, Clinical Profile, and Cardiovascular Outcomes of Atrial Fibrillation Patients with Atherothrombosis
Resource
AMERICAN HEART JOURNAL v.156 n.5 pp.855-863
Journal
American Heart Journal
Pages
855-863.e2
Date Issued
2008
Date
2008
Author(s)
Goto, Shinya
Bhatt, Deepak L.
Rother, Joachim
Alberts, Mark
Hill, Michael D.
Ikeda, Yasuo
Uchiyama, Shinichiro
D'Agostino, Ralph
Ohman, E. Magnus
Liau, Chiau-Suong
Hirsch, Alan T.
Mas, Jean-Louis
Wilson, Peter W.F.
Corbalan, Ramon
Aichner, Franz
Abstract
Background Atrial fibrillation (AF) is a major risk factor ( RF) for ischemic stroke. Its prevalence and prognostic impact in patients with atherothrombosis are unclear. Methods Risk factors, drug usage, and 1-year cardiovascular( CV) outcomes (CV death, myocardial infarction [MI], and stroke) were compared in AF and non-AF patients from the REduction of Atherothrombosis for Continued Health (REACH) Registry, an international, prospective cohort of 68,236 stable outpatients with established otherothrombosis or >= 3 atherothrombotic RFs. Result Atrial fibrillation and 1-year follow-up data are available for 63,589 patients. The prevalence of AF was, 12.5%, 13.7%, 11.5%, and 6.2% among coronary artery disease, CV disease, peripheral artery disease, and RF-only patients, respectively. Of the 6,814 patients with AF, 6.7% experienced CV death, nonfatal MI, or nonfatal stroke within a year. The annual incidence of nonfatal stroke (2.4% vs 1.6%, P < .0001) and unstable angina (6.0% vs 4.0 %, P < .00001) was higher, and CV death was more than double (3.2% vs 1.4% , P < .0001), in AF versus non-AF patients. In these patients with or at high risk of atherothrombosis, most patients with AF received antiplatelet agents, but only 53.1% were treated with oral anticoagulants. Even with high CHADS(2) (congestive heart failure, hypertension, aging, diabetes mellitus, and stroke) scores, anticoagulant use did not exceed (59%). The rate of bleeding requiring hospitalization was higher in AF versus non-AF patients (1.5% vs 0.8%, P < .0001), possibly related to the more frequent use of anticoagulants (53.1% vs 7.1%). Conclusions Atrial fibrillation is common in patients with atherothrombosis, associated with more frequent fatal and nonfatal CV outcomes, and underuse of oral anticoagulants.
SDGs
Other Subjects
acetylsalicylic acid; anticoagulant agent; antithrombocytic agent; aged; aging; artery disease; article; atherosclerosis; bleeding; cardiovascular risk; comparative study; congestive heart failure; controlled study; coronary artery disease; diabetes mellitus; drug use; female; follow up; heart atrium fibrillation; heart death; heart infarction; hospitalization; human; hypertension; major clinical study; male; outcome assessment; prevalence; priority journal; prognosis; prospective study; risk factor; stroke; thrombosis; unstable angina pectoris
Type
journal article