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

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

England

2017-07-06T15:37:02Z

2017-07-06T15:37:02Z

2015-06

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.

https://www.ncbi.nlm.nih.gov/pubmed/25732748

heartjnl-2014-307043

1468-201X

https://hdl.handle.net/10161/15008

eng

BMJ

Heart

10.1136/heartjnl-2014-307043

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

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

Journal article

Peterson, Eric D|0000-0002-5415-4721

Piccini, Jonathan P|0000-0003-0772-2404

https://www.ncbi.nlm.nih.gov/pubmed/25732748

894

899

11

Basic Science Departments

Biostatistics & Bioinformatics

Clinical Science Departments

Duke

Duke Clinical Research Institute

Institutes and Centers

Medicine

Medicine, Cardiology

School of Medicine

Published

101