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Heart rate is associated with progression of atrial fibrillation, independent of rhythm.

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Date
2015-06
Authors
Holmqvist, Fredrik
Kim, Sunghee
Steinberg, Benjamin A
Reiffel, James A
Mahaffey, Kenneth W
Gersh, Bernard J
Fonarow, Gregg C
Naccarelli, Gerald V
Chang, Paul
Freeman, James V
Kowey, Peter R
Thomas, Laine
Peterson, Eric D
Piccini, Jonathan P
ORBIT-AF Investigators
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Abstract
OBJECTIVE: Atrial fibrillation (AF) often progresses from paroxysmal or persistent to more sustained forms, but the rate and predictors of AF progression in clinical practice are not well described. METHODS: Using the Outcomes Registry for Better Informed Treatment of AF, we analysed the incidence and predictors of progression and tested the discrimination and calibration of the HATCH (hypertension, age, TIA/stroke, chronic obstructive pulmonary disease, heart failure) and CHA₂DS₂VASc scores for identifying AF progression. RESULTS: Among 6235 patients with paroxysmal or persistent AF at baseline, 1479 progressed, during follow-up (median 18 (IQR 12-24) months). These patients were older and had more comorbidities than patients who did not progress (CHADS₂ 2.3±1.3 vs 2.1±1.3, p<0.0001). At baseline, patients with AF progression were more often on a rate control as opposed to a rhythm control strategy (66 vs 56%, p<0.0001) and had higher heart rate (72(64-80) vs 68(60-76) bpm, p<0.0001). The strongest predictors of AF progression were AF on the baseline ECG (OR 2.30, 95% CI 1.95 to 2.73, p<0.0001) and increasing age (OR 1.16, 95% CI1.09 to 1.24, p<0.0001, per 10 increase), while patients with lower heart rate (OR 0.84, 95% CI 0.79 to 0.89, p<0.0001, per 10 decrease ≤80) were less likely to progress. There was no significant interaction between rhythm on baseline ECG and heart rate (p=0.71). The HATCH and CHA₂DS₂VASc scores had modest discriminatory power for AF progression (C-indices 0.55 (95% CI 0.53 to 0.58) and 0.55 (95% CI 0.52 to 0.57)). CONCLUSIONS: Within 1.5 years, almost a quarter of the patients with paroxysmal or persistent AF progress to a more sustained form. Progression is strongly associated with heart rate, and age.
Type
Journal article
Subject
Age Factors
Aged
Aged, 80 and over
Atrial Fibrillation
Cohort Studies
Disease Progression
Female
Heart Failure
Heart Rate
Humans
Hypertrophy, Left Ventricular
Male
Risk Factors
Permalink
https://hdl.handle.net/10161/15008
Published Version (Please cite this version)
10.1136/heartjnl-2014-307043
Publication Info
Holmqvist, Fredrik; Kim, Sunghee; Steinberg, Benjamin A; Reiffel, James A; Mahaffey, Kenneth W; Gersh, Bernard J; ... ORBIT-AF Investigators (2015). Heart rate is associated with progression of atrial fibrillation, independent of rhythm. Heart, 101(11). pp. 894-899. 10.1136/heartjnl-2014-307043. Retrieved from https://hdl.handle.net/10161/15008.
This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.
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Scholars@Duke

Peterson

Eric David Peterson

Fred Cobb, M.D. Distinguished Professor of Medicine
Dr Peterson is the Fred Cobb Distinguished Professor of Medicine in the Division of Cardiology, a DukeMed Scholar, and the Past Executive Director of the Duke Clinical Research Institute (DCRI), Durham, NC, USA. Dr Peterson is the Principal Investigator of the National Institute of Health, Lung and Blood Institute (NHLBI) Spironolactone Initiation Registry Randomized Interventional Trial in Heart Failure With Preserved Ejection Fraction (SPIRRIT) Trial  He is also the Principal I
This author no longer has a Scholars@Duke profile, so the information shown here reflects their Duke status at the time this item was deposited.
Piccini

Jonathan Paul Piccini Sr.

Associate Professor of Medicine
Jonathan P. Piccini, MD, MHS, FACC, FAHA, FHRS is a clinical cardiac electrophysiologist and Associate Professor of Medicine with Tenure at Duke University Medical Center and the Duke Clinical Research Institute. He is the Director of the Cardiac Electrophysiology section at the Duke Heart Center. His focus is on the care of patients with atrial fibrillation and complex arrhythmias, with particular emphasis on catheter ablation, left atrial appendage occlusion, and lead extraction. His resear

Benjamin Steinberg

House Staff
Thomas

Laine Elliott Thomas

Associate Professor of Biostatistics & Bioinformatics
Causal Inference, Heterogeneity of Treatment Effects, Observational Data, Time-varying Treatments, Real World Evidence
Alphabetical list of authors with Scholars@Duke profiles.
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