Prevalence, clinical profile, and cardiovascular outcomes of atrial fibrillation patients with atherothrombosis. Obesity and outcomes among patients with established atrial fibrillation. Focused 2012 update of the Canadian Cardiovascular Society atrial fibrillation guidelines: recommendations for stroke prevention and rate/rhythm control. Relation of Nonvalvular Atrial Fibrillation to Body Mass Index (from the SPORTIF Trials). Risks of cardiovascular events and effects of routine blood pressure lowering among patients with type 2 diabetes and atrial fibrillation: results of the ADVANCE study. Prevalence of atrial fibrillation in elderly subjects (the Cardiovascular Health Study). Association of Anti–Heat Shock Protein 65 Antibodies With Development of Postoperative Atrial Fibrillation Atrial fibrillation is independently associated with senile, vascular, and Alzheimer's dementia. Combined impact of healthy lifestyle factors on risk of atrial fibrillation: Prospective study in men and women. Randomized trial of rate-control versus rhythm-control in persistent atrial fibrillation: the Strategies of Treatment of Atrial Fibrillation (STAF) study. Risk factors for atrial fibrillation and their population burden in postmenopausal women: the Women's Health Initiative Observational Study Atrial fibrillation: the rate versus rhythm management controversy. Optimal treatment strategy for patients with paroxysmal atrial fibrillation: J-RHYTHM Study. Hemostatic state and atrial fibrillation (the Framingham Offspring Study). Anemia and reduced kidney function as risk factors for new onset of atrial fibrillation (from the Ibaraki prefectural health study). Clinical predictors of atrial fibrillation recurrence in the Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico-Atrial Fibrillation (GISSI-AF) trial. Close bidirectional relationship between chronic kidney disease and atrial fibrillation: the Niigata preventive medicine study. Gender-specific relationship between serum uric acid level and atrial fibrillation prevalence. The long- and short-term impact of elevated body mass index on the risk of new atrial fibrillation the WHS (women's health study). Long-term cardiovascular outcomes in patients with atrial fibrillation and atherothrombosis in the REACH Registry. Validation of the Risk Estimator Decision Aid for Atrial Fibrillation (RED-AF) for predicting 30-day adverse events in emergency department patients with atrial fibrillation. Hyperuricemia and the risk of ischemic stroke in patients with atrial fibrillation--could it refine clinical risk stratification in AF? Development of a Basic Risk Score for Incident Atrial Fibrillation in a Japanese General Population　- The Suita Study.
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 infa rct ion [ MI ] , and stroke ) were compared in  AF and non-AF patients from the REduction of Atherothrombosis for Continued Health ( REACH ) Registry , an international , prospect i ve cohort of 68,236 stable out patients with established atherothrombosis or > or=3 atherothrombotic RFs . RESULTS 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 CHADS2 ( 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 Atrial fibrillation ( AF ) and obesity have reached epidemic proportions . The impact of obesity on clinical outcomes in patients with established AF is unknown . We analyzed 2,492 patients in the Atrial Fibrillation Follow-Up Investigation of Rhythm Management ( AFFIRM ) study .  Body mass index ( BMI ) was evaluated as a categorical variable ( normal 18.5 to < 25 kg/m(2 ) , overweight 25 to < 30 kg/m(2 ) , obese > or=30 kg/m(2 ) ) . Rate of death from any cause was higher in the normal BMI group ( 5.8 per 100 patient-years ) than in the overweight and obese groups ( 3.9 and 3.7 , respectively ) . Cardiovascular death rate was highest in the normal BMI group ( 3.1 per 100 patient-years ) , lowest in the overweight group ( 1.5 per 100 patient-years ) , and intermediate in the obese group ( 2.1 per 100 patient-years ) . After adjustment for baseline factors , differences in risk of death from any cause were no longer significant . However , overweight remained associated with a lower risk of cardiovascular death ( hazard ratio 0.47 , p = 0.002 ) . Obese patients were more likely to have an uncontrolled heart rate at rest , but rhythm-control strategy success was similar across BMI categories . In each BMI category , risk of death from any cause was similar for patients r and omized to a rhythm- or rate-control strategy . In conclusion , in patients with established AF , overweight and obesity do not adversely affect overall survival . Obesity does not appear to affect the relative benefit of a rate- or rhythm-control strategy The Canadian Cardiovascular Society ( CCS ) published the complete set of 2010 Atrial Fibrillation ( AF ) Guidelines in the January , 2011 issue of the Canadian Journal of Cardiology . During its deliberations , the CCS Guidelines Committee engaged to a timely review of future evidence , with periodic composition of focused up date s to address clinical ly important advances . In 2011 , results were published from 3 pivotal AF trials : the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonist for Prevention of Stroke and Embolism Trial in Atrial Fibrillation ( ROCKET-AF ) , the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation ( ARISTOTLE ) study , and the Permanent Atrial Fibrillation Outcome Study Using Dronedarone on Top of St and ard Therapy ( PALLAS ) , comparing dronedarone with placebo in patients with permanent AF and additional cardiovascular disease risk-factor burden . Each of these large r and omized trials provided clear results with major implication s for AF management . Other important evidence that has emerged since the 2010 Guidelines includes findings about prediction instruments for AF-associated stroke and bleeding risk , stroke risk in paroxysmal-AF patients , risk-benefit considerations related to oral anticoagulation in patients with chronic kidney disease , and risk/benefit considerations in the use of antiplatelet agents , alone and in combination with each other or with oral anticoagulants , in AF patients . The Guidelines Committee judged that this extensive and important new evidence required focused updating of the 2010 Guidelines with respect to stroke prevention and rate/rhythm control . This report presents the details of the new recommendations , along with the background and rationale Obesity is well-established as a major cardiovascular ( CV ) risk factor . Obesity confers a greater risk for developing atrial fibrillation ( AF ) , but the relation between obesity and established nonvalvular AF for stroke and all-cause death is still unclear . To ascertain the prevalence of overweight and obesity in patients with nonvalvular AF , their influence on adverse events , and the relation with anticoagulation control , we performed this post hoc analysis of the pooled Stroke Prevention using an Oral Thrombin Inhibitor in patients with atrial Fibrillation ( SPORTIF ) III and V data sets . For this study , we analyzed all patients assigned to the warfarin arm with data on body mass index ( BMI ) . Time in therapeutic range was used as an index of the quality of anticoagulation control . The 3,630 patients eligible for this analysis were categorized as follows : ( 1 ) BMI 18.5 to 24.9 ( " normal weight " ) in 24.1 % ; ( 2 ) BMI 25.0 to 29.9 ( " overweight " ) in 39.8 % ; and BMI ≥30 ( " obese " ) in 36.1 % . Both overweight ( hazard ratio [ HR ] 0.70 ) and obese ( HR 0.59 ) categories were inversely associated with the composite outcome of stroke/all-cause death . A similar inverse association was seen for the end point of stroke ( HR 0.61 and 0.47 , respectively ) . Good anticoagulation control also attenuated the association between BMI categories and outcomes . In patients with time in therapeutic range > 70 % , BMI category was not significantly associated with the composite outcome of stroke/death and stroke . Stroke and all-cause death progressively reduced in overweight and obese anticoagulated patients with AF . The inverse relation of BMI categories to the risk of stroke and all-cause death was mitigated by good anticoagulation control AIMS The aim of this study was to investigate serious clinical outcomes associated with atrial fibrillation ( AF ) and the effects of routine blood pressure lowering on such outcomes in the presence or absence of AF , among individuals with type 2 diabetes . METHODS AND RESULTS About 11 140 patients with type 2 diabetes ( 7.6 % of whom had AF at baseline ) were r and omized to a fixed combination of perindopril and indapamide or placebo in the Action in Diabetes and Vascular Disease : preterAx and diamicroN-MR Controlled Evaluation ( ADVANCE ) study . We compared total mortality and cardiovascular disease outcomes and effects of r and omized treatment for 4.3 years on such outcomes between patients with and without AF at baseline . After multiple adjustments , AF was associated with a 61 % ( 95 % confidence interval 31 - 96 , P < 0.0001 ) greater risk of all-cause mortality and comparable higher risks of cardiovascular death , stroke , and heart failure ( all P < 0.001 ) . Routine treatment with a fixed combination of perindopril and indapamide produced similar relative , but greater absolute , risk reductions for all-cause and cardiovascular mortalities in patients with AF , compared with those without AF . The number of patients needed to be treated with perindopril-indapamide for 5 years to prevent one cardiovascular death was 42 for patients with AF and 120 for patients without AF at baseline . CONCLUSION Atrial fibrillation is relatively common in type 2 diabetes and is associated with substantially increased risks of death and cardiovascular events in patients with type 2 diabetes . This arrhythmia identifies individuals who are likely to obtain greater absolute benefits from blood pressure-lowering treatment . Atrial fibrillation in diabetic patients should be regarded as a marker of particularly adverse outcome and prompt aggressive management of all risk factors Atrial  fibrillation ( AF ) is a common arrhythmia in elderly persons and a common cause of embolic stroke . Most studies of the prevalence and correlates of AF have used selected , hospital-based population s. The Cardiovascular Health Study is a population -based , longitudinal study of risk factors for coronary artery disease and stroke in 5,201 men and women aged > or = 65 years .  AF  was diagnosed in 4.8 % of women and in 6.2 % of men at the baseline examination , and prevalence was strongly associated with advanced age in women . Prevalence of AF  was 9.1 % in men and women with clinical cardiovascular disease , 4.6 % in patients with evidence of sub clinical but no clinical cardiovascular disease , and only 1.6 % in subjects with neither clinical nor sub clinical cardiovascular disease . A history of congestive heart failure , valvular heart disease and stroke , echocardiographic evidence of enlarged left atrial dimension , abnormal mitral or aortic valve function , treated systemic hypertension , and advanced age were independently associated with the prevalence of AF .  The low prevalence of AF in the absence of clinical and sub clinical cardiovascular disease calls into question the existence and clinical usefulness of the concept of so-called " lone atrial fibrillation " in the elderly Background —Atrial fibrillation ( AF ) is a frequently encountered arrhythmia after cardiac surgery , but its underlying mechanisms are still unclear . We hypothesize that autoimmune and inflammatory responses against heat shock protein 65 ( HSP65 ) may be involved and hence examined the relationship between HSP65 autoantibodies and occurrence of postoperative AF . Methods and Results —A prospect i ve study of 329 patients undergoing elective primary CABG was undertaken .  Cardiovascular risk factors , ECG characteristics , medications , and intraoperative and postoperative features were documented . Anti-HSP65 antibodies and C-reactive protein levels were measured in all preoperative blood sample s with ELISA .  Postoperative AF was defined as the characteristic arrhythmia , lasting for at least 15 minutes and confirmed on 12-lead ECG and occurring within the first postoperative week . This occurred in 62 patients ( 19 % ) . In univariate analysis , HSP65 antibodies were significantly higher in patients with postoperative AF ( P=0.02 ) . History of previous myocardial infa rct ion , duration of bypass , number of distal anastomosis , and duration of ventilation were also associated with AF ( P<0.05 ) , but C-reactive protein levels were not ( P=0.13 ) . Multivariate analysis confirmed the positive association of HSP65 antibodies with postoperative AF ( OR , 1.41 ; P=0.04 ) independent of age , sex , other cardiovascular risk factors , severity of coronary artery disease , duration of ventilation , duration of bypass , and left ventricular function . Conclusions —We report a novel association between anti-HSP65 antibodies and occurrence of postoperative AF , indicating a possible role for antibody-mediated immune response in its pathogenesis BACKGROUND The aging population has result ed in more patients living with cardiovascular disease , such as atrial fibrillation ( AF ) . Recent focus has been placed on underst and ing the long-term consequences of chronic cardiovascular disease , such as a potential increased risk of dementia . OBJECTIVE This study sought to determine whether there is an association between AF and dementia and whether their coexistence is an independent marker of risk . METHODS A total of 37,025 consecutive patients from the large ongoing prospect i ve Intermountain Heart Collaborative Study data base were evaluated and followed up for a mean of 5 years for the development of AF and dementia . Dementia was sub-typed into vascular ( VD ) , senile ( SD ) , Alzheimer 's ( AD ) , and nonspecified ( ND ) . RESULTS Of the 37,025 patients with a mean age of 60.6 + /- 17.9 years , 10,161 ( 27 % ) developed AF and 1,535 ( 4.1 % ) developed dementia ( 179 VD , 321 SD , 347 AD , 688 ND ) during the 5-year follow-up . Patients with dementia were older and had higher rates of hypertension , coronary artery disease , renal failure , heart failure , and prior strokes . In age-based analysis , AF independently was significantly associated with all dementia types . The highest risk was in the younger group ( < 70 ) . After dementia diagnosis , the presence of AF was associated with a marked increased risk of mortality ( VD : hazard ratio [ HR ] = 1.38 , P = .01 ; SD : HR = 1.41 , P = .001 ; AD : HR = 1.45 ; ND : HR = 1.38 , P < .0001 ) . CONCLUSION AF was independently associated with all forms of dementia . Although dementia is strongly associated with aging , the highest risk of AD was in the younger group , in support of the observed association . The presence of AF also identified dementia patients at high risk of death BACKGROUND The combined impact of multiple lifestyle factors on risk of atrial fibrillation ( AF )  remains unclear . We investigated the joint association of four modifiable lifestyle factors on incidence of AF in a prospect i ve study of men and women . METHODS The study cohort comprised 39 300 men in the Cohort of Swedish Men and 33 090 women in the Swedish Mammography Cohort who were 45 - 83 years of age and free from atrial fibrillation at baseline . Healthy lifestyle was defined as body mass index < 25 kg/m(2 ) , regular exercise for ≥ 20 min/day , no or light-to-moderate alcohol consumption ( ≤ 2 drinks/day for men and ≤ 1 drink/day for women ) , and not smoking . Incident AF cases were identified through linkage with the Swedish National Inpatient Register . RESULTS During a mean follow-up of 10.9 years , AF occurred in 4028 men and 2539 women . Compared with men and women with no healthy lifestyle factors , the multivariable relative risks ( 95 % confidence interval ) of AF were 0.83 ( 0.65 - 1.07 ) for one , 0.74 ( 0.58 - 0.94 ) for two , 0.62 ( 0.49 - 0.79 ) for three , and 0.50 ( 0.39 - 0.64 ) for four healthy lifestyle factors ( P for trend < 0.0001 ) . The inverse association was similar in men and women . CONCLUSIONS Four healthy lifestyle factors combined were associated with a halving of the risk of AF OBJECTIVES This study was design ed to compare two treatment strategies in patients with atrial fibrillation(AF ) :  rhythm-control ( restoration and maintenance of sinus rhythm ) and rate-control ( pharmacologic or invasive rate-control and anticoagulation ) . BACKGROUND Atrial fibrillation is the most common arrhythmia . It is unclear whether a strategy of rhythm- or rate-control is better in terms of mortality , morbidity , and quality of life . METHODS The Strategies of Treatment of Atrial Fibrillation ( STAF ) multicenter pilot trial r and omized 200 patients ( 100 per group ) with persistent AF to rhythm- or rate-control .  The combined primary end point was a combination of death , cardiopulmonary resuscitation , cerebrovascular event , and systemic embolism . RESULTS After 19.6 + /- 8.9 months ( range 0 to 36 months ) there was no difference in the primary end point between rhythm-control ( 9/100 ; 5.54%/year ) and rate-control ( 10/100 ; 6.09%/year ; p = 0.99 ) . The percentage of patients in sinus rhythm in the rhythm-control group after up to four cardioversions during the follow-up period ( rate-control group ) was 23 % ( 0 % ) at 36 months . Eighteen primary end points occurred in atrial fibrillation ; only one occurred in sinus rhythm ( p = 0.049 ) . CONCLUSIONS The STAF pilot study showed no differences between the two treatment strategies in all end points except hospitalizations . These data suggest that there was no benefit in attempting rhythm-control in these patients with a high risk of arrhythmia recurrence . It remains unclear whether the results in the rhythm-control group would have been better if sinus rhythm had been maintained in a higher proportion of patients , as all but one end point occurred during AF Objective Atrial fibrillation ( AF ) is the most common arrhythmia in women . Large studies evaluating key AF risk factors in older women are lacking . We aim ed to identify risk factors for AF  in postmenopausal women and measure population burden of modifiable risk factors . Design Prospect i ve observational study . Setting The Women 's Health Initiative ( WHI ) Observational Study . Patients 93 676 postmenopausal women were followed for an average of 9.8 years for cardiovascular outcomes . After exclusion of women with prevalent AF or incomplete data , 8252 of the remaining 81 892 women developed incident AF . Main outcome measures Incident AF was identified by WHI-ascertained hospitalisation records and diagnosis codes from Medicare cl aims . Multivariate Cox hazard regression analysis identified independent risk factors for incident AF . Results Age , hypertension , obesity , diabetes , myocardial infa rct ion and heart failure were independently associated with incident AF . Hypertension and overweight status accounted for 28.3 % and 12.1 % , respectively , of the population attributable risk . Hispanic and African – American participants had lower rates of incident AF ( HR 0.58 , 95 % CI 0.47 to 0.70 and HR 0.59 , 95 % CI 0.53 to 0.65 , respectively ) than Caucasians . Conclusions Caucasian ethnicity , traditional cardiovascular risk factors and peripheral arterial disease were independently associated with higher rates of incident AF  in postmenopausal women . Hypertension and overweight status accounted for a large proportion of population attributable risk . Measuring burden of modifiable AF risk factors in older women may help target interventions The fundamental management strategy for atrial fibrillation ( AF ) is still debated . There is no doubt that those patients at risk of thromboembolic events should be offered anticoagulant therapy . However , it is uncertain whether rhythm control ( restoration and maintenance of sinus rhythm ) or rate control ( adjustment to a physiological ventricular rate while allowing AF to continue ) is the preferred primary treatment option for the reduction of symptoms and major cardiovascular ( CV ) outcomes associated with AF . Several well conducted trials comparing the two strategies led to the conclusion that there was little to choose between them . However , guidelines leaned towards recommending rate control as the initial strategy , and reserved rhythm control for those who remained symptomatic . Recently this status quo is being increasingly challenged by the clear demonstration that left atrial catheter ablation is effective at suppressing AF resistant to traditional antiarrhythmic drugs , such as those that failed to demonstrate any superiority when compared with rate control . Also , recently introduced antiarrhythmic therapy may have superior efficacy with regard to reducing unexpected CV hospitalization , CV mortality and stroke . In addition , there is a growing perception that atrial remodelling should be best prevented by early rhythm control rather than delaying until rate control has proven unsatisfactory . For these reasons the results of large r and omised clinical trials , which recruit patients soon after the presentation of AF and compare ' aggressive ' modern rhythm control against the guideline approach of primary rate control , are eagerly awaited . In the meantime the pendulum of clinical opinion has begun to swing towards a rhythm control strategy Background Although previous clinical trials demonstrated the non-inferiority of a rate control to rhythm control strategy for management of atrial fibrillation ( AF ) , the optimal treatment strategy for paroxysmal AF ( PAF ) remains unclear . Methods and Results A r and omized , multicenter comparison of rate control vs rhythm control in Japanese patients with PAF ( the Japanese Rhythm Management Trial for Atrial Fibrillation ( J-RHYTHM ) study ) was conducted . The primary endpoint was a composite of total mortality , symptomatic cerebral infa rct ion , systemic embolism , major bleeding , hospitalization for heart failure , or physical/psychological disability requiring alteration of treatment strategy . In the study , 823 patients with PAF were followed for a mean period of 578 days . The primary endpoint occurred in 64 patients ( 15.3 % ) assigned to rhythm control and in 89 patients ( 22.0 % ) to rate control ( P=0.0128 ) . No significant differences between the treatment strategies were observed in the incidences of death , stroke , bleeding and heart failure . Meanwhile , significantly fewer patients requested changes of assigned treatment strategy in the rhythm control vs the rate control group , which was accompanied by improvement in AF-specific quality of life scores . Conclusion The J-RHYTHM study showed that rhythm control was associated with fewer primary endpoints than rate control . However , mortality and cardiovascular morbidity were not affected by the treatment strategy ( umin-CTR No. C000000106 ) Atrial fibrillation ( AF ) is strongly associated with thromboembolic complications , although the mechanism for the increased risk has not been fully explained . To determine whether AF might be associated with a hypercoagulable state , we studied hemostatic factors in subjects with or without AF in the Framingham Heart Study . In 3,577 subjects , we measured  fibrinogen , von Willebr and factor antigen , tissue plasminogen activator ( tPA ) antigen , and plasminogen activator inhibitor-1 antigen .  Forty-seven subjects had AF at the index clinic examination and 15 had AF on a prior examination , but not on the current examination .  Before matching , the 47 subjects with prevalent AF had higher levels of fibrinogen , von Willebr and factor , and tPA antigen than those without AF , all p < or = 0.03 . Compared with 167 referent subjects matched for age , sex , and other risk factors , those with AF had higher tPA antigen levels than those without AF , 1 1.8 + /- 4.0 ng/ml versus 10.5 + /- 3.9 ng/ml ( p = 0.04 ) . However , when further stratified according to their cardiovascular disease status , the differences in hemostatic factors were no longer significant . We conclude that the prothrombotic profile associated with AF was explained by the risk factors of the subjects and the presence of cardiovascular disease . Nonetheless , the hemostatic changes may contribute toward the propensity for thromboembolic complications in AF . Further prospect i ve studies are needed to evaluate whether measurement of these and other hemostatic factors will identify patients with AF who are at increased risk for thromboembolic complications , and who may therefore benefit from more intensive therapy Chronic kidney disease ( CKD ) is a potential independent risk factor for  atrial fibrillation ( AF ) .  It remains unclear whether anemia is synergistically associated with increased risk of AF onset  in subjects with CKD . We evaluated the association of kidney function , hemoglobin ( Hb ) , and their combination with new-onset AF in a population -based cohort study . We conducted a 15-year prospect i ve cohort study of 132,250 Japanese subjects aged 40 to 79 years who participated in annual health checkups from 1993 .  Kaplan-Meier survival analysis was used to compare freedom from new-onset AF between groups classified by estimated glomerular filtration rate grade , Hb grade , and their combination . Cox proportional hazard model analysis was used to estimate hazard ratios ( HRs ) for new-onset AF . During a 13.8-year mean follow-up period , 1,232 ( 0.93 % ) subjects with  new-onset AF were identified . Lower estimated glomerular filtration rate and lower Hb grade s were significantly associated with a higher incidence of new-onset AF . Multivariate HRs and 95 % confidence intervals ( CIs ) of new-onset AF were 1.38 ( 1.21 to 1.56 ) for mild CKD group , 2.56 ( 2.09 to 3.13 ) for CKD group , and 1.50 ( 1.24 to 1.83 ) for anemia group . Borderline Hb level was not significantly associated with increased risk for new-onset AF ( HR 1.07 , CI 0.91 to 1.25 , p = 0.4284 ) . In the model with interaction term between CKD and anemia , the risk was significantly higher ( p = 0.0343 for the interaction ) than that predicted by each factor independently . In conclusion , decreased kidney function and lower Hb level are associated with increased risk for new-onset AF , especially when both are present BACKGROUND Atrial fibrillation ( AF ) is a common arrhythmia that frequently recurs after restoration of sinus rhythm ( SR ) . Identifying risk factors for recurrence may help define the best strategy for secondary prevention . METHODS The GISSI-AF trial enrolled 1,442 patients in SR with at least 2 documented AF episodes in the previous 6 months or after cardioversion in the last 2 weeks . Patients were r and omized to valsartan or placebo ; all other treatments for AF or underlying heart diseases were allowed . Primary end points were time to first recurrence of AF and proportion of patients with > 1 AF episode during 1-year follow-up . We evaluated  clinical and electrocardiographic baseline characteristics  of all patients to identify independent predictors for AF recurrence using a Cox multivariable model . RESULTS Risk factors for AF recurrence were a history of 2 or more AF episodes in the previous 6 months , independent of the modality of SR restoration , spontaneous ( HR 1.42 , 95 % CI 1.14 - 1.77 , P = .002 ) , or by cardioversion ( HR 1.19 , 95 % CI 1.01 - 1.40 , P = .038 ) , and a lower heart rate during SR ( HR 0.99 , 95 % CI 0.99 - 1.00 , P = .052 ) . The risk factors were the same for > 1 AF recurrence . Patients treated with amiodarone had a lower risk for both end points ( P < .0001 and P = .017 ) , whereas those on diuretics had a greater risk ( P = .009 and P = .003 ) . CONCLUSIONS In the GISSI-AF study population , AF history had significant prognostic value independent of the modality of SR restoration . Amiodarone and diuretic treatment affected the rate of AF recurrence BACKGROUND Atrial fibrillation ( AF ) and chronic kidney disease share risk factors and pathophysiologic mechanisms , suggesting that two conditions have close relationships . METHODS This is a prospect i ve community-based observational cohort study including 235,818 subjects based upon a voluntary annual health check-up program in Japan . We studied the association of kidney dysfunction at entry with subsequent new-onset AF  and the association of AF at entry with the development of kidney disease . RESULTS During a follow-up of 5.9 + /- 2.4 years , AF developed in 2947 subjects ( 1.3 % ) .  Baseline serum creatinine and estimated glomerular filtration rate ( GFR ) were associated with risk of subsequent AF . The HRs ( 95 % CI ) for AF were 1.32 ( 1.08 - 1.62 ) and 1.57 ( 0.89 - 2.77 ) for GFR 30 to 59 and < 30 mL/min per 1.73 m(2 ) , respectively . The effect of kidney disease on risk of new-onset AF remained significant in subjects without treated hypertension or diabetes . During the follow-up , 7791 subjects ( 3.3 % ) developed kidney dysfunction ( GFR < 60 mL/min per 1.73 m(2 ) ) , and 11 307 subjects ( 4.9 % ) developed proteinuria .  Atrial fibrillation at entry was associated with development of kidney dysfunction ( HRs [ 95 % CI ] , 1.77 [ 1.50 - 2.10 ] ) and proteinuria ( HR [ 95 % CI ] , 2.20 [ 1.92 - 2.52 ] ) . The association persisted in subjects without treated hypertension or diabetes . CONCLUSIONS Kidney dysfunction increased the risk of new onset of AF , and AF increased the risk of development of kidney disease . This finding supports the concept that the two conditions share common abnormal molecular signaling pathways contributing to their pathogenesis BACKGROUND Although various kinds of cardiovascular risk factors have been reported to be associated with  atrial fibrillation ( AF )  , the relationship between serum uric acid level and AF has not been fully examined . METHODS AND RESULTS Data were collected from a single hospital-based cohort in the Shinken Data base 2004 - 2008 ( n=11,123 ) , and consisted of serum uric acid level for 7,155 patients . The association between serum uric acid level and AF prevalence was evaluated on logistic regression . Uric acid significantly increased the crude AF prevalence in both men and women ( both , P<0.001 ) . The odds ratio ( OR ) and 95 % confidence interval ( 95%CI ) in the highest tertile compared with the lowest one were 3.368 ( 2.478 - 4.578 ) and 1.408 ( 1.169 - 1.695 ) in women and men , respectively . Uric acid was also significantly associated with other various cardiovascular risk factors for AF . Even after the multivariate model was adjusted using these variables , the effect of uric acid on AF was independent in women ( OR , 1.888 ; 95%CI : 1.278 - 2.790 ) , but not in men . CONCLUSIONS Reflecting the composite of various cardiovascular risk factors , serum uric acid level was apparently associated with AF prevalence . The independent association in women might imply some sex-specific mechanisms . The results should be confirmed in prospect i ve studies OBJECTIVES The purpose of this study was to characterize the relationship between changes in  body mass index ( BMI ) and incident atrial fibrillation ( AF ) in a large cohort of women . BACKGROUND Obesity and AF are increasing public health problems . The importance of dynamic obesity-associated AF risk is uncertain , and mediators are not well characterized . METHODS Cases of AF were confirmed by medical record review in 34,309 participants in the Women 's Health Study . Baseline and up date d measures of  BMI  were obtained from periodic question naires . RESULTS During 12.9 + /- 1.9 years of follow-up , 834 AF events were confirmed . BMI was linearly associated with AF risk , with a 4.7 % ( 95 % confidence interval [ CI ] : 3.4 to 6.1 , p < 0.0001 ) increase in risk with each kilogram per square meter . Adjustment for inflammatory markers minimally attenuated this risk . When up date d measures of BMI were used to estimate dynamic risk , overweight ( hazard ratio [ HR ] : 1.22 ; 95 % CI : 1.02 to 1.45 , p = 0.03 ) , and obesity ( HR : 1.65 ; 95 % CI : 1.36 to 2.00 ; p < 0.0001 ) were associated with adjusted short-term increases in AF risk . Participants becoming obese during the first 60 months had a 41 % adjusted increase in risk of the development of AF ( p = 0.02 ) compared with those maintaining BMI < 30 kg/m(2 ) . The prevalence of overweight and obesity increased over time . The adjusted proportion of incident AF attributable to short-term elevations in BMI was substantial ( 18.3 % ) . CONCLUSIONS In this population of apparently healthy women , BMI was associated with short- and long-term increases in AF risk , accounting for a large proportion of incident AF independent of traditional risk factors . A strategy of weight control may reduce the increasing incidence of AF . ( Women 's Health Study [ WHS ] : A R and omized Trial of Low-Dose Aspirin and Vitamin E in the Primary Prevention of Cardiovascular Disease and Cancer ; NCT00000479 ) BACKGROUND Patients with atrial fibrillation ( AF )  are at increased risk of thromboembolic events . The long-term prognostic implication s 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 , prospect i ve 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 STUDY OBJECTIVE In the United States , nearly 70 % of emergency department ( ED ) visits for atrial fibrillation result in hospitalization . The incidence of serious 30-day adverse events after an ED evaluation for atrial fibrillation remains low . This study 's goal was to prospect ively vali date our previously reported Risk Estimator Decision Aid for Atrial Fibrillation ( RED-AF ) model for estimating a patient 's risk of experiencing a 30-day adverse event . METHODS This was a prospect i ve cohort study , which enrolled a convenience sample of ED patients presenting with atrial fibrillation .  RED-AF , previously derived from a retrospective cohort of 832 patients , assigns points according to age , sex , coexisting disease ( eg , heart failure , hypertension , chronic obstructive pulmonary disease ) , smoking , home medications ( eg , β-blocker , diuretic ) , physical examination findings ( eg , dyspnea , palpitations , peripheral edema ) , and adequacy of ED ventricular rate control . Primary outcome was occurrence of greater than or equal to 1 atrial fibrillation-related adverse outcome ( ED visits , rehospitalization , cardiovascular complications , death ) within 30 days . We identified a clinical ly relevant threshold and measured RED-AF 's performance in this prospect i ve cohort , assessing its calibration , discrimination , and diagnostic accuracy . RESULTS The study enrolled 497 patients between June 2010 and February 2013 . Of these , 120 ( 24 % ) had greater than or equal to 1 adverse event within 30 days . A RED-AF score of 87 was identified as an optimal threshold , result ing in sensitivity and specificity of 96 % ( 95 % confidence interval [ CI ] 91 % to 98 % ) and 19 % ( 95 % CI 15 % to 23 % ) , respectively . Positive and negative predictive values were 27 % ( 95 % CI 23 % to 32 % ) and 93 % ( 95 % CI 85 % to 97 % ) , respectively . The c statistic for RED-AF was 0.65 ( 95 % CI 0.59 to 0.71 ) . CONCLUSION In this separate validation cohort , RED-AF performed moderately well and similar to the original derivation cohort for identifying the risk of short-term atrial fibrillation-related adverse events in ED patients receiving a diagnosis of atrial fibrillation BACKGROUND Although hyperuricemia has been reported to be a risk factor of stroke , the relationship between hyperuricemia and stroke in patients with atrial fibrillation ( AF ) remains uncertain . The goal of the present study was to investigate whether hyperuricemia could potentially refine clinical risk stratification in AF . METHODS This study used the " National Health Insurance Research Data base " in Taiwan . A total of 7601 AF patients who did not receive antiplatelet agents or oral anticoagulants were identified as the study population . Hyperuricemia was defined as having at least one episode of gout attack necessitating long-term treatment with uric acid-lowering agents . The association between hyperuricemia and ischemic stroke was analyzed . RESULTS During the follow up of 3.0±2.7 years , 1116 patients ( 14.7 % ) experienced ischemic stroke with an annual rate of around 4.9 % . Hyperuricemia significantly predicts stroke , with a hazard ratio ( HR ) of 1.280 after adjusting for CHA2DS2-VASc score and other comorbidities . Among the 376 patients with a CHA2DS2VASc score of 0 , hyperuricemia can further stratify them into 2 groups with different stroke rates ( 7.1 % versus 1.3 % , p=0.020 ) . The adjusted HR of hyperuricemia in predicting ischemic stroke diminished from 7.491 for patients with a CHA2DS2-VASc score of 0 to 1.659 for those with a score of 3 , and became insignificant for patients with a score ≥4 . CONCLUSIONS Hyperuricemia was a significant risk factor of stroke which could potentially refine the clinical risk stratification in AF . It deserves a prospect i ve trial to investigate whether it would change the current strategy for stroke preventions using oral anticoagulants BACKGROUND An atrial fibrillation ( AF ) risk score for a non-Western general population has not been established . Methods and Results : A total of 6,898 participants ( 30 - 79 years old ) initially free of AF have been prospect ively followed for incident AF since 1989 . AF was diagnosed when AF or atrial flutter was present on ECG at a biannual health examination ; was indicated as a current illness ; or was in the medical records during follow-up . Cox proportional hazard ratios were analyzed after adjusting for cardiovascular risk factors at baseline . During the 95,180 person-years of follow-up , 311 incident AF events occurred . We developed a scoring system for each risk factor as follows : 0/-5 , 3/0 , 7/5 , and 9/9 points for men/women in their 30 s-40 s , 50 s , 60 s , and 70 s , respectively ; 2 points for systolic hypertension , overweight , excessive drinking , or coronary artery disease ; 1 point for current smoking ; -1 point for moderate non-high-density lipoprotein-cholesterol ; 4 points for arrhythmia ; and 8 , 6 , and 2 points for subjects with cardiac murmur in their 30 s-40 s , 50 s , and 60 s , respectively ( C-statistic 0.749 ; 95 % confidence interval , 0.724 - 0.774 ) . Individuals with score ≤2 , 10 - 11 , or ≥16 points had , respectively , ≤1 % , 9 % , and 27 % observed probability of developing AF in 10 years . CONCLUSIONS We developed a 10-year risk score for incident AF using traditional risk factors that are easily obtained in routine outpatient clinics/health examinations without ECG
A systematic evaluation of the available evidence suggests similarities as well as important differences in the risk factors for incidence of AF as compared with other cardiovascular diseases , which has implication s for the primary prevention strategies for atrial fibrillation
Established primary prevention strategies of cardiovascular diseases are based on underst and ing of risk factors , but whether the same risk factors are associated with  atrial fibrillation ( AF )  remains unclear .