Prognosis in patients with atrial fibrillation and a presumed "temporary cause" in a community-based cohort study.
BACKGROUND
Atrial fibrillation (AF) may be related to acute and temporary causes, whether cardiovascular or non-cardiovascular. It remains unclear whether the risk of ischemic stroke is different in this setting, and whether antithrombotic management should be different in these patients. The objective of the study was to describe and compare the risk of stroke in AF patients with and with no such temporary precipitating cause.


METHODS
Among 8962 patients with AF seen between 2000 and 2010, we focused our analysis on 4587 patients with non-permanent AF, of whom 740 (16 %) had at least one possible temporary cause of AF.


RESULTS
During a mean follow-up of 944 days (median 451, interquartile range 8-1624), the adjusted rates of stroke/TE were non-significantly different between patients with a temporary cause of AF and other AF patients (HR = 1.08, 95 % CI 0.82-1.41, p = 0.59 after adjustment on age, gender, CHA2DS2VASc score, OAC use and antiplatelet therapy use). Cardiovascular mortality was higher in patients with a temporary cause when compared to other AF patients (adjusted HR = 1.42, 95 % CI 1.08-1.86, p = 0.01). In patients with a temporary cause of AF, prescription of oral anticoagulation was independently associated with a better prognosis for cardiovascular death/stroke/thromboembolism (HR = 0.44, 95 % CI 0.29-0.67, p = 0.0001).


CONCLUSIONS
AF patients with presumed temporary cause of AF had a similar risk of stroke/thromboembolism and a worse prognosis for cardiovascular mortality than other AF patients. Use of oral anticoagulation was associated with a better prognosis in these patients.
Service de Cardiologie et Laboratoire d'Electrophysiologie Cardiaque, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université François Rabelais, 37044, Tours, France. lfau@med.univ-tours.fr.
Laurent
L
Fauchier
Service de Cardiologie et Laboratoire d'Electrophysiologie Cardiaque, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université François Rabelais, 37044, Tours, France.
Nicolas
N
Clementy
Service de Cardiologie et Laboratoire d'Electrophysiologie Cardiaque, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université François Rabelais, 37044, Tours, France.
Arnaud
A
Bisson
Service de Cardiologie, Centre Hospitalier Universitaire de Dijon et Université de Bourgogne, Dijon, France.
Karim
K
Stamboul
Service de Cardiologie et Laboratoire d'Electrophysiologie Cardiaque, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université François Rabelais, 37044, Tours, France.
Fabrice
F
Ivanes
Service de Cardiologie et Laboratoire d'Electrophysiologie Cardiaque, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université François Rabelais, 37044, Tours, France.
Denis
D
Angoulvant
Service de Cardiologie et Laboratoire d'Electrophysiologie Cardiaque, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université François Rabelais, 37044, Tours, France.
Dominique
D
Babuty
University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Birmingham, B18 7QH, UK.|Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
Gregory Y H
GY
Lip
D000284:Administration, Oral; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage*; D001281:Atrial Fibrillation / Q000150:complications* / Q000503:physiopathology; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D015996:Survival Rate / Q000639:trends; D013923:Thromboembolism / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D013997:Time Factors
D000925:Anticoagulants
Atrial fibrillation; Oral anticoagulant; Stroke
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