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New-onset AF among healthy women associated with mortality

Conen D. JAMA. 2011;305:2080-2087.

Miyasaka Y. JAMA. 2011;305:2116-2117.

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In a group of nearly 35,000 healthy women, new-onset atrial fibrillation was found to be independently associated with all-cause, CV and non-CV mortality.

To generate these findings, David Conen, MD, MPH, and researchers examined participants (n=34,722; 95% white; median age, 53 years) of the Women’s Health Study who were free of AF and CVD at baseline. Primary outcome measures were all-cause, CV and non-CV mortality, whereas secondary measures were MI, stroke and congestive HF.

During a median of 15.4 years, 1,011 participants developed AF (64.9% paroxysmal), with 63 deaths reported among them. This resulted in the following HRs for new-onset AF: all-cause mortality, 2.14 (95% CI, 1.64-2.77); CV mortality, 4.18 (95% CI, 2.69-6.51); and non-CV mortality, 1.66 (95% CI, 1.19-2.30). For women with paroxysmal AF, only mortality risk from CV causes was notably increased (HR=2.94; 95% CI, 1.55-5.59).

Although adjustment for nonfatal CV events potentially leading to death limited these relationships, the researchers wrote that new-onset AF remained significantly associated with all forms of mortality.

Additionally, they found that both new-onset AF and new-onset paroxysmal AF were strong risk factors for the secondary measures, as well as the composite of all three.

“Because a significant proportion of the excess mortality risk appears attributable to the occurrence of nonfatal CV events prior to death, there is a potential opportunity to improve the outcome of individuals with new-onset AF through both prevention and optimal management of these associated comorbidities,” the researchers concluded.

In an accompanying editorial, Yoko Miyasaka, MD, PhD,of Kansai Medical University, Hirakata, Japan, and Teresa S. M. Tsang, MD, of the University of British Columbia, Vancouver, Canada, wrote that this study provides compelling evidence that the first detection of AF in otherwise event-free middle-aged women is associated with a significantly higher mortality risk and possibly reflects an existing higher CV risk burden, including subclinical structural substrates of AF.

“Whether treatment of AF including stroke prevention and aggressive management of CV risk factors can reverse the mortality risk associated with AF among these women awaits future studies,” they said.

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