title: Atrial fibrillation and the risk of sudden cardiac death: the atherosclerosis risk in communities study and cardiovascular health study.
abstract: BACKGROUND
  It is unknown whether atrial fibrillation (AF) is associated with an increased risk of sudden cardiac death (SCD) in the general population. This association was examined in 2 population-based cohorts.
  
  
  METHODS
  In the Atherosclerosis Risk in Communities (ARIC) Study, we analyzed data from 15 439 participants (baseline age, 45-64 years; 55.2% women; and 26.6% black) from baseline (1987-1989) through December 31, 2001. In the Cardiovascular Health Study (CHS), we analyzed data from 5479 participants (baseline age, ≥65 years; 58.2% women; and 15.4% black) from baseline (first cohort, 1989-1990; second cohort, 1992-1993) through December 31, 2006. The main outcome was physician-adjudicated SCD, defined as death from a sudden, pulseless condition presumed to be due to a ventricular tachyarrhythmia. The secondary outcome was non-SCD (NSCD), defined as coronary heart disease death not meeting SCD criteria. We used Cox proportional hazards models to assess the association between AF and SCD/NSCD, adjusting for baseline demographic and cardiovascular risk factors.
  
  
  RESULTS
  In the ARIC Study, 894 AF, 269 SCD, and 233 NSCD events occurred during follow-up (median, 13.1 years). The crude incidence rates of SCD were 2.89 per 1000 person-years (with AF) and 1.30 per 1000 person-years (without AF). The multivariable hazard ratios (HRs) (95% CIs) of AF for SCD and NSCD were 3.26 (2.17-4.91) and 2.43 (1.60-3.71), respectively. In the CHS, 1458 AF, 292 SCD, and 581 NSCD events occurred during follow-up (median, 13.1 years). The crude incidence rates of SCD were 12.00 per 1000 person-years (with AF) and 3.82 per 1000 person-years (without AF). The multivariable HRs (95% CIs) of AF for SCD and NSCD were 2.14 (1.60-2.87) and 3.10 (2.58-3.72), respectively. The meta-analyzed HRs (95% CIs) of AF for SCD and NSCD were 2.47 (1.95-3.13) and 2.98 (2.52-3.53), respectively.
  
  
  CONCLUSIONS
  Incident AF is associated with an increased risk of SCD and NSCD in the general population. Additional research to identify predictors of SCD in patients with AF is warranted.
authors: Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, University of Minnesota, Minneapolis, MN 55455, USA. chenx484@umn.edu
authors: Lin Y
authors: LY
authors: Chen
authors: Nona
authors: N
authors: Sotoodehnia
authors: Petra
authors: P
authors: Bůžková
authors: Faye L
authors: FL
authors: Lopez
authors: Laura M
authors: LM
authors: Yee
authors: Susan R
authors: SR
authors: Heckbert
authors: Ronald
authors: R
authors: Prineas
authors: Elsayed Z
authors: EZ
authors: Soliman
authors: Selcuk
authors: S
authors: Adabag
authors: Suma
authors: S
authors: Konety
authors: Aaron R
authors: AR
authors: Folsom
authors: David
authors: D
authors: Siscovick
authors: Alvaro
authors: A
authors: Alonso
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications / Q000208:ethnology / Q000401:mortality; D002318:Cardiovascular Diseases / Q000453:epidemiology; D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000209:etiology; D003710:Demography; D005006:Ethnicity; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D014481:United States / Q000453:epidemiology
references: JAMA. 1960 Sep 24;174:384-8
references: 13833138
references: J Cardiovasc Electrophysiol. 2000 Nov;11(11):1208-14
references: 11083241
references: Circulation. 1998 Sep 8;98(10):946-52
references: 9737513
references: JAMA. 2011 May 25;305(20):2080-7
references: 21610240
references: Circulation. 2006 Jul 11;114(2):119-25
references: 16818816
references: Circulation. 2003 Jun 17;107(23):2920-5
references: 12771006
references: Stroke. 1991 Aug;22(8):983-8
references: 1866765
references: Am Heart J. 2009 Jul;158(1):111-7
references: 19540400
references: Eur Heart J. 2006 Feb;27(3):290-5
references: 16267070
references: J Am Coll Cardiol. 2007 Mar 6;49(9):986-92
references: 17336723
references: Am J Epidemiol. 1989 Apr;129(4):687-702
references: 2646917
references: Circulation. 1991 Jul;84(1):40-8
references: 2060110
references: Heart. 2011 Oct;97(19):1597-601
references: 21775508
references: Ann Epidemiol. 1991 Feb;1(3):263-76
references: 1669507
references: Nat Genet. 2009 Aug;41(8):879-81
references: 19597492
references: JAMA. 1994 Mar 16;271(11):840-4
references: 8114238
references: Am Heart J. 2010 Sep;160(3):464-70
references: 20826254
references: JAMA. 2001 May 9;285(18):2370-5
references: 11343485
references: Circulation. 1997 Oct 7;96(7):2455-61
references: 9337224
references: Am J Cardiol. 1984 Feb 1;53(4):508-15
references: 6198893
references: Am J Ther. 2004 Jan-Feb;11(1):33-43
references: 14704594
references: J Clin Epidemiol. 1996 Feb;49(2):223-33
references: 8606324
references: Eur Heart J. 2011 Dec;32(24):3098-106
references: 21785106
references: Circulation. 1992 Jan;85(1 Suppl):I11-8
references: 1370216
references: Circulation. 1974 Jan;49(1):32-41
references: 4271710
references: Int J Clin Pract. 2009 May;63(5):712-21
references: 19392921