title: Asymptomatic atrial fibrillation: clinical correlates, management, and outcomes in the EORP-AF Pilot General Registry.
abstract: OBJECTIVE
  Atrial fibrillation is often asymptomatic, but outcomes require further characterization. The study objective was to investigate the clinical presentation, management, and outcomes in asymptomatic and symptomatic patients with atrial fibrillation who were prospectively enrolled in the EurObservational Research Programme - Atrial Fibrillation (EORP-AF) Pilot General Registry.
  
  
  METHODS
  A total of 3119 patients were enrolled, and 1237 (39.7%) were asymptomatic (European Heart Rhythm Association [EHRA] score I). Among symptomatic patients, 963 (51.2%) had mild symptoms (EHRA score II) and 919 (48.8%) had severe or disabling symptoms (EHRA III-IV). Permanent atrial fibrillation was 3-fold more common in asymptomatic patients than in symptomatic patients.
  
  
  RESULTS
  On multivariate analysis, male gender (odds ratio [OR], 1.630; 95% confidence interval [CI], 1.384-1.921), older age (OR, 1.019; 95% CI, 1.012-1.026), previous myocardial infarction (OR, 1.681; 95% CI, 1.350-2.093), and limited physical activity (OR, 1.757; 95% CI, 1.495-2.064) were associated significantly with asymptomatic (EHRA I) atrial fibrillation. Fully asymptomatic atrial fibrillation (absence of current and previous symptoms) was present in 520 patients (16.7%) and was associated independently with male gender, age, and previous myocardial infarction. Appropriate guideline-based prescription of oral anticoagulants was lower in these patients, and aspirin was prescribed more frequently. Mortality at 1 year was more than 2-fold higher in asymptomatic patients compared with symptomatic patients (9.4% vs 4.2%, P < .0001) and was associated independently with older age and comorbidities, including chronic kidney disease and chronic heart failure.
  
  
  CONCLUSIONS
  Asymptomatic atrial fibrillation is common in daily cardiology practice and is associated with elderly age, more comorbidities, and high thromboembolic risks. A higher 1-year mortality was found in asymptomatic patients compared with symptomatic patients.
authors.affiliation: Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S. Orsola-Malpighi University Hospital, Bologna, Italy. Electronic address: giuseppe.boriani@unibo.it.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Boriani
authors.affiliation: EurObservational Research Programme Department, European Society of Cardiology, Sophia Antipolis, France.
authors.forename: Cecile
authors.initials: C
authors.lastname: Laroche
authors.affiliation: Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S. Orsola-Malpighi University Hospital, Bologna, Italy.
authors.forename: Igor
authors.initials: I
authors.lastname: Diemberger
authors.affiliation: Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S. Orsola-Malpighi University Hospital, Bologna, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Fantecchi
authors.affiliation: Faculty of Medicine, Cardiology Department, Oradea, Romania.
authors.forename: Mircea Ioachim
authors.initials: MI
authors.lastname: Popescu
authors.affiliation: Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Medicine Aalborg University, Aalborg, Denmark.
authors.forename: Lars Hvilsted
authors.initials: LH
authors.lastname: Rasmussen
authors.affiliation: University of Trieste, Ospedale di Cattinara, AOU Ospedali Riuniti SC Cardiologia, Trieste, Italy.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Sinagra
authors.affiliation: Institute of Cardiovascular Diseases, Coronary Unit and Cardiology 1, University of Medicine and Pharmacy "Victor Babes," Timisoara, Romania.
authors.forename: Lucian
authors.initials: L
authors.lastname: Petrescu
authors.affiliation: Maria Cecilia Hospital, GVM Care & Research, E.S. Health Science Foundation, Cotignola, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Tavazzi
authors.affiliation: EurObservational Research Programme, European Society of Cardiology, Sophia Antipolis, France.
authors.forename: Aldo P
authors.initials: AP
authors.lastname: Maggioni
authors.affiliation: University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom.
authors.forename: Gregory Y H
authors.initials: GY
authors.lastname: Lip
mesh_terms: D000368:Aged; D058070:Asymptomatic Diseases; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D012042:Registries; D012737:Sex Factors
keywords: Atrial fibrillation; Bleeding; Mortality; Registry; Stroke