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Cardiologist care confers survival benefit in AF
Patients newly diagnosed with atrial fibrillation were more likely to survive 1 year after diagnosis if they sought care of a cardiologist, according to new findings.
Researchers conducted a retrospective population-level propensity-matched cohort study of 22,032 patients who presented to an ED in Ontario, Canada, with a primary diagnosis of AF to determine the association between cardiologist care and clinical outcomes, including all-cause mortality.
“Variations in AF care across medical specialties are well-known,” Sheldon M. Singh, MD, cardiologist at Sunnybrook Health Sciences Centre and assistant professor of cardiology and electrophysiology at the University of Toronto, said in a press release. “Other than stroke prevention therapy, no other therapy has been associated with improved survival in patients with AF. Heart failure and sudden death account for 35% to 50% of AF deaths, so we hypothesized that comprehensive cardiovascular care beyond stroke prevention may improve overall survival in AF patients.”
As Cardiology Today previously reported, a U.S. study found that patients with newly diagnosed AF who saw a cardiologist had reduced risk for stroke at 90 days vs. those who did not see a cardiologist.
Among the Canadian cohort, 85% saw a cardiologist within 1 year of the index visit. After propensity-score matching, 2,902 patients who saw a cardiologist were compared with 2,902 patients who did not (mean age, 64 years; 56% men). Among those who did not see a cardiologist, 94% saw a family physician and 55% saw a noncardiology internal medicine specialist during the follow-up period.
Survival benefit
At 1 year, 5.3% of those who saw a cardiologist died vs. 7.7% of those who did not see a cardiologist (HR = 0.68; 95% CI, 0.55-0.84), according to the researchers.
Compared with those who did not see a cardiologist, those who did see one had higher rates of hospitalizations for AF (17.9% vs. 8.2%; HR = 2.3; 95% CI, 2-2.7), stroke syndromes (1.7% vs. 0.5%; HR = 3.4; 95% CI, 1.8-6.1), bleeding (3.1% vs. 2%; HR = 1.5; 95% CI, 1.1-2.1) and HF (3.2% vs. 1.4%; HR = 2.2; 95% CI, 1.5-3.1), Singh and colleagues wrote.
“Our findings should stimulate further research to determine the specific components of care which may allow patients with AF to live longer,” Singh said in the release. “This is particularly important as access to cardiologist care is not universal.”
Collaborative care
In a related editorial, Stephen B. Wilton, MD, MSc, assistant professor of cardiology at the Libin Cardiovascular Institute of Alberta, Calgary, wrote that the death rate in the cohort was high given the relatively young mean age and relatively light comorbidity burden.
“Therefore, a new diagnosis of AF, while not immediately life-threatening, should be regarded as an important marker of near-term risk of cardiovascular events,” he wrote. “This observation alone provides a potential rationale for desiring early cardiovascular specialist evaluation for these patients.”
More important, he wrote, is “prompt access to collaborative care, regardless of who is delivering it. ... Especially in the increasing proportion of those with AF who are asymptomatic, we can empower family physicians to perform initial investigations and initiate stroke prevention therapy.” – by Erik Swain
Disclosure: The authors and Wilton report no relevant financial disclosures.