Long-term risk of adverse outcomes according to atrial fibrillation type
Authors: Blum Steffen , Aeschbacher Stefanie , Coslovsky Michael , Meyre Pascal B. , Reddiess Philipp , Ammann Peter , Erne Paul , Moschovitis Giorgio , Di Valentino Marcello , Shah Dipen , Schläpfer Jürg , Müller Rahel , Beer Jürg H. , Kobza Richard , Bonati Leo H. , Moutzouri Elisavet , Rodondi Nicolas , Meyer-Zürn Christine , Kühne Michael , Sticherling Christian , Osswald Stefan , Conen David ,   the BEAT-AF and Swiss-AF investigators, Aeschbacher Stefanie , Auberson Chloé , Blum Steffen , Bonati Leo , Ceylan Selinda , Conen David , Evers-Doerpfeld Simone , Eken Ceylan , Girod Marc , Hennings Elisa , Herber Elena , Iten Vasco , Krisai Philipp , Lampart Maurin , Lischer Mirko , Meyer-Zürn Christine , Meyre Pascal , Monsch Andreas U. , Müller Christian , Paladini Rebecca E. , Springer Anne , Sticherling Christian , Szucs Thomas , Völlmin Gian , Osswald Stefan , Kühne Michael , Aujesky Drahomir , Fischer Urs , Fuhrer Juerg , Roten Laurent , Jung Simon , Mattle Heinrich , Netzer Seraina , Adam Luise , Aubert Carole Elodie , Feller Martin , Loewe Axel , Moutzouri Elisavet , Schneider Claudio , Flückiger Tanja , Groen Cindy , Ehrsam Lukas , Hellrigl Sven , Nuoffer Alexandra , Rakovic Damiana , Schwab Nathalie , Wenger Rylana , Saffari Tu Hanh Zarrabi , Rodondi Nicolas , Reichlin Tobias , Beynon Christopher , Dillier Roger , Deubelbeiss Michèle , Eberli Franz , Franzini Christine , Juchli Isabel , Liedtke Claudia , Murugiah Samira , Nadler Jacqueline , Obst Thayze , Roth Jasmin , Schlomowitsch Fiona , Schneider Xiaoye , Studerus Katrin , Tynan Noreen , Weishaupt Dominik , Müller Andreas , Fontana Simone , Friedli Corinne , Kuest Silke , Scheuch Karin , Hischier Denise , Bonetti Nicole , Grau Alexandra , Villinger Jonas , Laube Eva , Baumgartner Philipp , Filipovic Mark , Frick Marcel , Montrasio Giulia , Leuenberger Stefanie , Rutz Franziska , Beer Jürg-Hans , Auricchio Angelo , Anesini Adriana , Camporini Cristina , Conte Giulio , Caputo Maria Luce , Regoli Francois , Moccetti Tiziano , Brenner Roman , Altmann David , Gemperle Michaela , Ammann Peter , Firmann Mathieu , Foucras Sandrine , Rime Martine , Hayoz Daniel , Berte Benjamin , Justi Virgina , Kellner-Weldon Frauke , Mehmann Brigitta , Meier Sonja , Roth Myriam , Ruckli-Kaeppeli Andrea , Russi Ian , Schmidt Kai , Young Mabelle , Zbinden Melanie , Kobza Richard , Rigamonti Elia , Cereda Carlo , Cianfoni Alessandro , De Perna Maria Luisa , Frangi-Kultalahti Jane , Melchiorre Patrizia Assunta Mayer , Pin Anica , Terrot Tatiana , Vicari Luisa , Moschovitis Giorgio , Ehret Georg , Gallet Hervé , Guillermet Elise , Lazeyras Francois , Lovblad Karl-Olof , Perret Patrick , Tavel Philippe , Teres Cheryl , Shah Dipen , Lauriers Nathalie , Méan Marie , Salzmann Sandrine , Schläpfer Jürg , Porretta Alessandra Pia , Grêt Andrea , Novak Jan , Vitelli Sandra , Stephan Frank-Peter , Frangi-Kultalahti Jane , Gallino Augusto , Vicari Luisa , Di Valentino Marcello , Aebersold Helena , Foster Fabienne , Schwenkglenks Matthias , Würfel Jens , Altermatt Anna , Amann Michael , Düring Marco , Huber Petra , Ruberte Esther , Sinnecker Tim , Zuber Vanessa , Coslovsky Michael , Benkert Pascal , Dutilh Gilles , Markovic Milica , Neuschwander Pia , Simon Patrick , Schmid Ramun 
Published: February 2022

Sustained forms of atrial fibrillation (AF) may be associated with a higher risk of adverse outcomes, but few if any long-term studies took into account changes of AF type and co-morbidities over time. We prospectively followed 3843 AF patients and collected information on AF type and co-morbidities during yearly follow-ups. The primary outcome was a composite of stroke or systemic embolism (SE). Secondary outcomes included myocardial infarction, hospitalization for congestive heart failure (CHF), bleeding and all-cause mortality. Multivariable adjusted Cox proportional hazards models with time-varying covariates were used to compare hazard ratios (HR) according to AF type. At baseline 1895 (49%), 1046 (27%) and 902 (24%) patients had paroxysmal, persistent and permanent AF and 3234 (84%) were anticoagulated. After a median (IQR) follow-up of 3.0 (1.9; 4.2) years, the incidence of stroke/SE was 1.0 per 100 patient-years. The incidence of myocardial infarction, CHF, bleeding and all-cause mortality was 0.7, 3.0, 2.9 and 2.7 per 100 patient-years, respectively. The multivariable adjusted (a) HRs (95% confidence interval) for stroke/SE were 1.13 (0.69; 1.85) and 1.27 (0.83; 1.95) for time-updated persistent and permanent AF, respectively. The corresponding aHRs were 1.23 (0.89, 1.69) and 1.45 (1.12; 1.87) for all-cause mortality, 1.34 (1.00; 1.80) and 1.30 (1.01; 1.67) for CHF, 0.91 (0.48; 1.72) and 0.95 (0.56; 1.59) for myocardial infarction, and 0.89 (0.70; 1.14) and 1.00 (0.81; 1.24) for bleeding. In this large prospective cohort of AF patients, time-updated AF type was not associated with incident stroke/SE.