Clinical Impact of Asymptomatic Presentation Status in Patients With Paroxysmal and Sustained Atrial Fibrillation: The Fushimi AF Registry.

Abstract

BACKGROUND:

The clinical characteristics and outcomes of asymptomatic patients with paroxysmal or persistent/permanent atrial fibrillation (AF) are largely unknown.

METHODS:

The Fushimi AF Registry is a community-based prospective survey of patients with AF who visited the participating medical institutions in Fushimi-ku, Japan. We investigated the clinical characteristics and outcomes of asymptomatic vs symptomatic patients in the paroxysmal AF (PAF; n = 1,837) and persistent/permanent (sustained atrial fibrillation [SAF]; n = 1,912) subgroups.

RESULTS:

In the PAF group, asymptomatic patients were older (asymptomatic vs symptomatic group, 74.1 vs 71.1 years of age; P < .01), more often male (62.1% vs 55.6%; P < .01), and had a higher CHA2DS2-VASc (congestive heart failure, hypertension, age ≥ 75 years, diabetes mellitus, history of stroke, vascular disease, age 65-74 years, and female sex) score (mean, 3.37 ± 1.73 vs 2.99 ± 1.63; P < .01), whereas the prevalence of major co-morbidities and CHA2DS2-VASc scores were comparable in the SAF group. Multivariable analysis indicated that age (≥ 75 years), history of stroke/systemic embolism, male sex, and chronic kidney disease were independent determinants of asymptomatic status in the PAF group, whereas age was nonsignificant in the SAF group. During the follow-up period, all-cause mortality was significantly higher (hazard ratio, 1.71 [95% CI, 1.31-2.29]; P < .01) in asymptomatic patients compared with symptomatic patients in the PAF group, whereas it was comparable in the SAF group.

CONCLUSIONS:

Asymptomatic clinical status is associated with older age, male sex, more co-morbidities with a higher stroke risk profile, and a higher incidence of all-cause death in patients with PAF; these characteristics and outcomes were not seen in the SAF group.

TRIAL REGISTRY:

UMIN Clinical Trials Registry; No.: UMIN000005834; URL: www.umin.ac.jp/ctr/index.htm.

• Authors: Masahiro Esato, Yeong-Hwa Chun, Yoshimori An, Hisashi Ogawa, Hiromichi Wada, Koji Hasegawa, Hikari Tsuji, Mitsuru Abe, Gregory Y H Lip, Masaharu Akao
• Journal: Chest (Chest) Vol. 152 Issue 6 Pg. 1266-1275 (12 2017) ISSN: 1931-3543 [Electronic] United States
• PMID: 28823813 (Publication Type: Clinical Trial, Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

Topics

• Asymptomatic Diseases
• Atrial Fibrillation (complications, diagnosis, epidemiology)
• Cause of Death (trends)
• Embolism (epidemiology, etiology)
• Heart Failure (epidemiology, etiology)
• Humans
• Incidence
• Japan (epidemiology)
• Magnetic Resonance Imaging
• Prevalence
• Prognosis
• Prospective Studies
• Registries
• Risk Assessment (methods)
• Survival Rate (trends)
• Tachycardia, Paroxysmal (diagnosis, epidemiology)
• Tomography, X-Ray Computed