Contributors: BEAT-AF and Swiss-AF investigators; Aeschbacher, S.; Auberson, C.; Blum, S.; Bonati, L.; Ceylan, S.; Conen, D.; Evers-Doerpfeld, S.; Eken, C.; Girod, M.; Hennings, E.; Herber, E.; Iten, V.; Krisai, P.; Lampart, M.; Lischer, M.; Meyer-Zürn, C.; Meyre, P.; Monsch, A.U.; Müller, C.; Paladini, R.E.; Springer, A.; Sticherling, C.; Szucs, T.; Völlmin, G.; Osswald, S.; Kühne, M.; Aujesky, D.; Fischer, U.; Fuhrer, J.; Roten, L.; Jung, S.; Mattle, H.; Netzer, S.; Adam, L.; Aubert, C.E.; Feller, M.; Loewe, A.; Moutzouri, E.; Schneider, C.; Flückiger, T.; Groen, C.; Ehrsam, L.; Hellrigl, S.; Nuoffer, A.; Rakovic, D.; Schwab, N.; Wenger, R.; Saffari, THZ; Rodondi, N.; Reichlin, T.; Beynon, C.; Dillier, R.; Deubelbeiss, M.; Eberli, F.; Franzini, C.; Juchli, I.; Liedtke, C.; Murugiah, S.; Nadler, J.; Obst, T.; Roth, J.; Schlomowitsch, F.; Schneider, X.; Studerus, K.; Tynan, N.; Weishaupt, D.; Müller, A.; Fontana, S.; Friedli, C.; Kuest, S.; Scheuch, K.; Hischier, D.; Bonetti, N.; Grau, A.; Villinger, J.; Laube, E.; Baumgartner, P.; Filipovic, M.; Frick, M.; Montrasio, G.; Leuenberger, S.; Rutz, F.; Beer, J.H.; Auricchio, A.; Anesini, A.; Camporini, C.; Conte, G.; Caputo, M.L.; Regoli, F.; Moccetti, T.; Brenner, R.; Altmann, D.; Gemperle, M.; Ammann, P.; Firmann, M.; Foucras, S.; Rime, M.; Hayoz, D.; Berte, B.
نبذة مختصرة : Sustained forms of atrial fibrillation (AF) may be associated with a higher risk of adverse outcomes, but few if any long-term studies took into account changes of AF type and co-morbidities over time. We prospectively followed 3843 AF patients and collected information on AF type and co-morbidities during yearly follow-ups. The primary outcome was a composite of stroke or systemic embolism (SE). Secondary outcomes included myocardial infarction, hospitalization for congestive heart failure (CHF), bleeding and all-cause mortality. Multivariable adjusted Cox proportional hazards models with time-varying covariates were used to compare hazard ratios (HR) according to AF type. At baseline 1895 (49%), 1046 (27%) and 902 (24%) patients had paroxysmal, persistent and permanent AF and 3234 (84%) were anticoagulated. After a median (IQR) follow-up of 3.0 (1.9; 4.2) years, the incidence of stroke/SE was 1.0 per 100 patient-years. The incidence of myocardial infarction, CHF, bleeding and all-cause mortality was 0.7, 3.0, 2.9 and 2.7 per 100 patient-years, respectively. The multivariable adjusted (a) HRs (95% confidence interval) for stroke/SE were 1.13 (0.69; 1.85) and 1.27 (0.83; 1.95) for time-updated persistent and permanent AF, respectively. The corresponding aHRs were 1.23 (0.89, 1.69) and 1.45 (1.12; 1.87) for all-cause mortality, 1.34 (1.00; 1.80) and 1.30 (1.01; 1.67) for CHF, 0.91 (0.48; 1.72) and 0.95 (0.56; 1.59) for myocardial infarction, and 0.89 (0.70; 1.14) and 1.00 (0.81; 1.24) for bleeding. In this large prospective cohort of AF patients, time-updated AF type was not associated with incident stroke/SE.
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