Christian T Ruff1, Deepak L Bhatt2, Ph Gabriel Steg3, Bernard J Gersh4, Mark J Alberts5, Elaine B Hoffman6, E Magnus Ohman7, Kim A Eagle8, Gregory Y H Lip9, Shinya Goto10. 1. TIMI Study Group, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: cruff@partners.org. 2. VA Boston Healthcare System, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. 3. INSERM U698, Universite' Paris 7, AP-HP, Paris, France. 4. Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN, USA. 5. Department of Neurology, Northwestern University Medical School, Chicago, IL, USA. 6. TIMI Study Group, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. 7. Division of Cardiology, Duke University, Durham, NC, USA. 8. University of Michigan Cardiovascular Center, Ann Arbor, MI, USA. 9. University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK. 10. Department of Medicine and the Metabolic Disease Center, Tokai University School of Medicine, Kanagawa, Japan.
Abstract
BACKGROUND: Patients with atrial fibrillation (AF) are at increased risk of thromboembolic events. The long-term prognostic implications of AF in patients with atherothrombosis are unknown. METHODS: We compared 4-year CV outcomes in patients with and without a history of AF recorded at their baseline visit in the REACH Registry, an international, prospective cohort of patients with established atherosclerotic arterial disease (CAD, CVD, PAD) or at least 3 risk factors (RFO). RESULTS: AF status and 4 year follow-up data were available on 44,518 patients. The prevalence of AF at baseline was 10.3% (n=4582). Overall, patients with AF had approximately a 2-fold increase in the composite of CV death, MI, or stroke compared with patients without AF after adjustment for age, gender, prior ischemic event, vascular disease, congestive heart failure, diabetes, smoking, body mass index, region, aspirin and statin use (18.9% vs. 9.4%, p<0.0001). This increased risk was observed both in patients with established atherothrombosis (CAD: 15.5% vs. 8.0%, p=0.0001; CVD: 23.6% vs. 13.6%, p<0.0001; PAD: 24.3% vs. 13.5%, p=0.089) and those with multiple risk factors (RFO: 12.1% vs. 5.9%, p=0.017). Only 52% of patients with a history of AF at baseline were receiving anticoagulation at 4 years. CONCLUSIONS: Patients with a history of both AF and atherothrombosis have particularly high long-term CV risk. Despite this increased risk, almost half of all patients with AF do not receive guideline recommended anticoagulation, highlighting an important public health priority.
BACKGROUND:Patients with atrial fibrillation (AF) are at increased risk of thromboembolic events. The long-term prognostic implications of AF in patients with atherothrombosis are unknown. METHODS: We compared 4-year CV outcomes in patients with and without a history of AF recorded at their baseline visit in the REACH Registry, an international, prospective cohort of patients with established atherosclerotic arterial disease (CAD, CVD, PAD) or at least 3 risk factors (RFO). RESULTS:AF status and 4 year follow-up data were available on 44,518 patients. The prevalence of AF at baseline was 10.3% (n=4582). Overall, patients with AF had approximately a 2-fold increase in the composite of CV death, MI, or stroke compared with patients without AF after adjustment for age, gender, prior ischemic event, vascular disease, congestive heart failure, diabetes, smoking, body mass index, region, aspirin and statin use (18.9% vs. 9.4%, p<0.0001). This increased risk was observed both in patients with established atherothrombosis (CAD: 15.5% vs. 8.0%, p=0.0001; CVD: 23.6% vs. 13.6%, p<0.0001; PAD: 24.3% vs. 13.5%, p=0.089) and those with multiple risk factors (RFO: 12.1% vs. 5.9%, p=0.017). Only 52% of patients with a history of AF at baseline were receiving anticoagulation at 4 years. CONCLUSIONS:Patients with a history of both AF and atherothrombosis have particularly high long-term CV risk. Despite this increased risk, almost half of all patients with AF do not receive guideline recommended anticoagulation, highlighting an important public health priority.
Authors: Jérémie Abtan; Deepak L Bhatt; Yedid Elbez; Emmanuel Sorbets; Kim Eagle; Yasuo Ikeda; David Wu; Mary E Hanson; Hakima Hannachi; Puneet K Singhal; Philippe Gabriel Steg; Gregory Ducrocq Journal: Clin Cardiol Date: 2016-09-02 Impact factor: 2.882
Authors: Gilles Lemesle; Gregory Ducrocq; Yedid Elbez; Eric Van Belle; Shinya Goto; Christopher P Cannon; Christophe Bauters; Deepak L Bhatt; Philippe Gabriel Steg Journal: Clin Cardiol Date: 2017-07-10 Impact factor: 2.882