Prevalence, clinical profile, and cardiovascular outcomes of atrial fibrillation patients with atherothrombosis.
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 infarction [MI], and stroke) were compared in AF and non-AF patients from the REduction of Atherothrombosis for Continued Health (REACH) Registry, an international, prospective cohort of 68,236 stable outpatients 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.
Goto
Shinya
S
Department of Medicine and Metabolic Disease Center, Tokai University School of Medicine, Tokai University, Kanagawa, Japan. shinichi@is.icc.u-tokai.ac.jp
Bhatt
Deepak L
DL
Röther
Joachim
J
Alberts
Mark
M
Hill
Michael D
MD
Ikeda
Yasuo
Y
Uchiyama
Shinichiro
S
D'Agostino
Ralph
R
Ohman
E Magnus
EM
Liau
Chiau-Suong
CS
Hirsch
Alan T
AT
Mas
Jean-Louis
JL
Wilson
Peter W F
PW
Corbalán
Ramón
R
Aichner
Franz
F
Steg
P Gabriel
PG
D000368:Aged; D050197:Atherosclerosis / Q000150:complications*; D001281:Atrial Fibrillation / Q000150:complications*; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D015995:Prevalence; D012307:Risk Factors; D013927:Thrombosis / Q000150:complications*