Clinical characteristics, management, and control of permanent vs. nonpermanent atrial fibrillation: insights from the RealiseAF survey.
BACKGROUND
Atrial fibrillation can be categorized into nonpermanent and permanent atrial fibrillation. There is less information on permanent than on nonpermanent atrial fibrillation patients. This analysis aimed to describe the characteristics and current management, including the proportion of patients with successful atrial fibrillation control, of these atrial fibrillation subsets in a large, geographically diverse contemporary sample.


RESULTS
Data from RealiseAF, an international, observational, cross-sectional survey of 10,491 patients with atrial fibrillation, were used to characterize permanent atrial fibrillation (N = 4869) and nonpermanent atrial fibrillation (N = 5622) patients. Permanent atrial fibrillation patients were older, had a longer time since atrial fibrillation diagnosis, a higher symptom burden, and were more likely to be physically inactive. They also had a higher mean (SD) CHADS2 score (2.2 [1.3] vs. 1.7 [1.3], p<0.001), and a higher frequency of CHADS2 score ≥2 (67.3% vs. 53.0%, p<0.001) and comorbidities, most notably heart failure. Physicians indicated using a rate-control strategy in 84.2% of permanent atrial fibrillation patients (vs. 27.5% in nonpermanent atrial fibrillation). Only 50.2% (N = 2262/4508) of permanent atrial fibrillation patients were controlled. These patients had a longer time since atrial fibrillation diagnosis, a lower symptom burden, less obesity and physical inactivity, less severe heart failure, and fewer hospitalizations for acute heart failure than uncontrolled permanent atrial fibrillation patients, but with more arrhythmic events. The most frequent causes of hospitalization in the last 12 months were acute heart failure and stroke.


CONCLUSIONS
Permanent atrial fibrillation is a high-risk subset of atrial fibrillation, representing half of all atrial fibrillation patients, yet rate control is only achieved in around half. Since control is associated with lower symptom burden and heart failure, adequate rate control is an important target for improving the management of permanent atrial fibrillation patients.
Department of Internal Medicine and Cardiology, Comenius University, Bratislava, Slovakia.
Jan
J
Murin
Global Strategic Unit Cardio-Thrombosis, Sanofi, Paris, France.
Lisa
L
Naditch-Brûlé
Statistician, Lincoln, Boulogne-Billancourt, France.
Sandrine
S
Brette
General Clinical Research Center, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan.
Chern-En
CE
Chiang
Connolly/Mater Hospitals/Royal College of Surgeons in Ireland, Dublin, Ireland.
James
J
O'Neill
Institut national de la santé et de la recherche médicale-U698, Paris, France; Université Paris Diderot, Sorbonne Paris Cite, Paris, France; Assistance publique - Hôpitaux de Paris, Hôpital Bichat, Paris, France.
P Gabriel
PG
Steg
D000368:Aged; D000369:Aged, 80 and over; D000638:Amiodarone / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000145:classification / Q000150:complications / Q000188:drug therapy*; D002318:Cardiovascular Diseases / Q000150:complications / Q000188:drug therapy*; D003430:Cross-Sectional Studies; D004077:Digoxin / Q000627:therapeutic use; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006306:Health Surveys / Q000379:methods / Q000706:statistics & numerical data*; D006321:Heart / Q000187:drug effects / Q000503:physiopathology; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012307:Risk Factors; D013015:Sotalol / Q000627:therapeutic use
D000889:Anti-Arrhythmia Agents; D004077:Digoxin; D013015:Sotalol; D000638:Amiodarone