title: Atrial fibrillation patterns and risks of subsequent stroke, heart failure, or death in the community.
abstract: BACKGROUND
  Atrial fibrillation (AF) patterns and their relations with long-term prognosis are uncertain, partly because pattern definitions are challenging to implement in longitudinal data sets. We developed a novel AF classification algorithm and examined AF patterns and outcomes in the community.
  
  
  RESULTS
  We characterized AF patterns between 1980 and 2005 among Framingham Heart Study participants who survived ≥ 1 year after diagnosis. We classified participants based on their pattern within the first 2 years after detection as having AF without recurrence, recurrent AF, or sustained AF. We examined associations between AF patterns and 10-year survival using proportional hazards regression. Among 612 individuals with AF, mean age was 72.5 ± 10.8 years, and 53% were men. Of these, 478 participants had ≥ 2 electrocardiograms (median, 3; limits 2 to 23) within 2 years after initial AF and were classified as having AF without 2-year recurrence (n = 63, 10%), recurrent AF (n = 162, 26%) or sustained AF (n = 207, 34%), although some (n = 46, 8%) were indeterminate. Of 432 classified participants, 363 died, 75 had strokes, and 110 were diagnosed with heart failure during the next 10 years. Relative to individuals without AF recurrence, the multivariable-adjusted mortality was higher among people with recurrent AF (hazard ratio [HR], 2.04; 95% confidence interval [CI], 1.26 to 3.29) and sustained AF (HR, 2.36; 95% CI, 1.49 to 3.75).
  
  
  CONCLUSIONS
  In our community-based AF sample, only 10% had AF without early-term (2-year) recurrence. Compared with individuals without 2-year AF recurrences, the 10-year prognosis was worse for individuals with either sustained or recurrent AF. Our proposed AF classification algorithm may be applicable in longitudinal data sets.
authors.affiliation: Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA.
authors.forename: Steven A
authors.initials: SA
authors.lastname: Lubitz
authors.forename: Carlee
authors.initials: C
authors.lastname: Moser
authors.forename: Lisa
authors.initials: L
authors.lastname: Sullivan
authors.forename: Michiel
authors.initials: M
authors.lastname: Rienstra
authors.forename: João D
authors.initials: JD
authors.lastname: Fontes
authors.forename: Mark L
authors.initials: ML
authors.lastname: Villalon
authors.forename: Manju
authors.initials: M
authors.lastname: Pai
authors.forename: David D
authors.initials: DD
authors.lastname: McManus
authors.forename: Renate B
authors.initials: RB
authors.lastname: Schnabel
authors.forename: Jared W
authors.initials: JW
authors.lastname: Magnani
authors.forename: Xiaoyan
authors.initials: X
authors.lastname: Yin
authors.forename: Daniel
authors.initials: D
authors.lastname: Levy
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Pencina
authors.forename: Martin G
authors.initials: MG
authors.lastname: Larson
authors.forename: Patrick T
authors.initials: PT
authors.lastname: Ellinor
authors.forename: Emelia J
authors.initials: EJ
authors.lastname: Benjamin
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications* / Q000401:mortality*; D005260:Female; D006333:Heart Failure / Q000209:etiology*; D006801:Humans; D008297:Male; D011379:Prognosis; D020521:Stroke / Q000209:etiology*
keywords: atrial fibrillation; heart failure; mortality; pattern; risk; stroke