title: Long-term cardiovascular outcomes in patients with atrial fibrillation and atherothrombosis in the REACH Registry.
abstract: BACKGROUND
  Patients with atrial fibrillation (AF) are at increased risk of thromboembolic events. The long-term prognostic implications of AF in patients with atherothrombosis are unknown.
  
  
  METHODS
  We compared 4-year CV outcomes in patients with and without a history of AF recorded at their baseline visit in the REACH Registry, an international, prospective cohort of patients with established atherosclerotic arterial disease (CAD, CVD, PAD) or at least 3 risk factors (RFO).
  
  
  RESULTS
  AF status and 4 year follow-up data were available on 44,518 patients. The prevalence of AF at baseline was 10.3% (n=4582). Overall, patients with AF had approximately a 2-fold increase in the composite of CV death, MI, or stroke compared with patients without AF after adjustment for age, gender, prior ischemic event, vascular disease, congestive heart failure, diabetes, smoking, body mass index, region, aspirin and statin use (18.9% vs. 9.4%, p<0.0001). This increased risk was observed both in patients with established atherothrombosis (CAD: 15.5% vs. 8.0%, p=0.0001; CVD: 23.6% vs. 13.6%, p<0.0001; PAD: 24.3% vs. 13.5%, p=0.089) and those with multiple risk factors (RFO: 12.1% vs. 5.9%, p=0.017). Only 52% of patients with a history of AF at baseline were receiving anticoagulation at 4 years.
  
  
  CONCLUSIONS
  Patients with a history of both AF and atherothrombosis have particularly high long-term CV risk. Despite this increased risk, almost half of all patients with AF do not receive guideline recommended anticoagulation, highlighting an important public health priority.
authors: TIMI Study Group, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: cruff@partners.org.
authors: Christian T
authors: CT
authors: Ruff
authors: VA Boston Healthcare System, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors: Deepak L
authors: DL
authors: Bhatt
authors: INSERM U698, Universite' Paris 7, AP-HP, Paris, France.
authors: Ph Gabriel
authors: PG
authors: Steg
authors: Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
authors: Bernard J
authors: BJ
authors: Gersh
authors: Department of Neurology, Northwestern University Medical School, Chicago, IL, USA.
authors: Mark J
authors: MJ
authors: Alberts
authors: TIMI Study Group, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors: Elaine B
authors: EB
authors: Hoffman
authors: Division of Cardiology, Duke University, Durham, NC, USA.
authors: E Magnus
authors: EM
authors: Ohman
authors: University of Michigan Cardiovascular Center, Ann Arbor, MI, USA.
authors: Kim A
authors: KA
authors: Eagle
authors: University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK.
authors: Gregory Y H
authors: GY
authors: Lip
authors: Department of Medicine and the Metabolic Disease Center, Tokai University School of Medicine, Kanagawa, Japan.
authors: Shinya
authors: S
authors: Goto
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D050197:Atherosclerosis / Q000453:epidemiology* / Q000401:mortality; D001281:Atrial Fibrillation / Q000453:epidemiology* / Q000401:mortality; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000401:mortality; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D005500:Follow-Up Studies; D006333:Heart Failure / Q000453:epidemiology / Q000401:mortality; D006801:Humans; D006949:Hyperlipidemias / Q000453:epidemiology / Q000401:mortality; D006973:Hypertension / Q000453:epidemiology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries / Q000706:statistics & numerical data; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000401:mortality; D013927:Thrombosis / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control; D013997:Time Factors
chemical_list: D005343:Fibrinolytic Agents
keywords: Anticoagulation; Atherosclerosis; Atrial fibrillation; Vascular disease