Prevalence and prognostic significance of device-detected subclinical atrial fibrillation in patients with heart failure and reduced ejection fraction
| Autor: | Rem-Hf Investigators, Martin R. Cowie, Jaswinder Gill, G. André Ng, Sue Kitt, Klaus K. Witte, Patrick C Phillips, Simon G. Williams, Alison Seed, David Wright, John M. Morgan, Rosita Zakeri, Janet M. McComb |
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| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Population Context (language use) 030204 cardiovascular system & hematology 03 medical and health sciences 0302 clinical medicine Risk Factors Internal medicine Atrial Fibrillation Prevalence Humans Medicine 030212 general & internal medicine education Stroke Subclinical infection Heart Failure education.field_of_study Ejection fraction business.industry Stroke Volume Atrial fibrillation Prognosis medicine.disease Heart failure Cohort Cardiology Cardiology and Cardiovascular Medicine business |
| Zdroj: | International Journal of Cardiology. 312:64-70 |
| ISSN: | 0167-5273 |
| DOI: | 10.1016/j.ijcard.2020.03.008 |
| Popis: | Background Cardiac implanted electronic devices (CIEDs) can detect short durations of previously unrecognised atrial fibrillation (AF). The prognostic significance of device-detected subclinical AF, in the context of contemporary heart failure (HF) therapy, is unclear. Methods Amongst patients enrolled in the Remote Monitoring in HF with implanted devices (REM-HF) trial, three categories were defined based on total AF duration in the first year of follow-up: no AF, subclinical AF (≥6 min to ≤24 h), and AF >24 h. All-cause mortality, stroke, and cardiovascular hospitalisation were assessed. Results 1561 patients (94.6%) had rhythm data: 71 (4.6%) had subclinical AF (median of 4 episodes, total duration 3.1 h) and 279 (17.9%) had AF >24 h. During 2.8 ± 0.8 years' follow-up, 39 (2.5%) patients had a stroke. Stroke rate was highest amongst patients with subclinical AF (2.0 per 100-person years) versus no AF or AF >24 h (0.8 and 1.0 per 100-person years, respectively). In the overall cohort, AF >24 h was not an independent predictor of stroke. However, amongst patients with no history of AF (n = 932), new-onset subclinical AF conferred a three-fold higher stroke risk (adjusted HR 3.35, 95%CI 1.15–9.77, p = 0.027). AF >24 h was associated with more frequent emergency cardiovascular hospitalisation (adjusted HR 1.46, 95%CI 1.19–1.79, p Conclusions In patients with HF and a CIED, subclinical AF was infrequent but, as a new finding, was associated with an increased risk of stroke. Anticoagulation remains an important consideration in this population, particularly when the clinical profile indicates a high stroke risk. |
| Databáze: | OpenAIRE |
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