Heart failure a more common complication than stroke in people with atrial fibrillation
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Key takeaways:
- From 2000 to 2022 in Denmark, the population-level lifetime risk for atrial fibrillation increased more than 6%.
- Heart failure, not stroke, was the most common CV complication for those with AF.
In a large Danish cohort, heart failure was a more significant CV complication than stroke after diagnosis of atrial fibrillation, which became more common over 20 years.
“To our knowledge, the temporal trends in lifetime risks of atrial fibrillation and complications after atrial fibrillation have not been reported previously,” Nicklas Vinter, MD, PhD, of the Danish Center for Health Services Research at Aalborg University in Denmark, and colleagues wrote in The BMJ. “Among patients with newly diagnosed atrial fibrillation, heart failure was the most frequent complication after atrial fibrillation, with a lifetime risk of about two in five, twice as large as the lifetime risk of stroke after atrial fibrillation and four times greater than the lifetime risk of myocardial infarction after atrial fibrillation.”
To assess trends in AF risk and of complications after diagnosis, Vinter and colleagues conducted a nationwide cohort study of 3.5 million Danish residents without AF aged 45 years or older (51.7% women) from 2000 to 2022. Participants were followed up until incident AF, migration, death or the end of the follow-up period.
Two decades of AF incidence and complications
During the entire study period, the lifetime risk for AF increased from 24.2% in 2000-2010 to 30.9% in 2011-2022 (difference, 6.7 percentage points; 95% CI, 6.5-6.8).
The researchers further followed 362,721 individuals with incident AF and no prevalent complication (46.4% women) until occurrence of incident HF, stroke or MI.
After incident AF, the most frequent complication was HF, with a lifetime risk of 42.9% in the 2000-2010 period and 42.1% in the 2011-2022 period, according to the study.
The lifetime risks for stroke and MI after incident AF were less than HF, and decreased slightly between the two periods. The frequency of stroke decreased from 22.4% in the 2000-2010 period to 19.9% in the 2011-2022 period (difference, –2.5 percentage points; 95% CI, –4.2 to –0.7). The frequency of MI decreased from 13.7% in the 2000-2010 period to 9.8% in the 2011-2022 period (difference, –3.9 percentage points; 95% CI, –5.3 to –2.4).
“Lifetime risk estimates provide epidemiological insights into the public health impact presented by atrial fibrillation and its complications. Communication of lifetime risk estimates may motivate preventive strategies, such as beneficial changes in lifestyle and strengthening of the focus on quality in medical care settings,” the researchers wrote. “Our findings encourage greater attention to secondary prevention of heart failure after atrial fibrillation, and in line with a recent report from the National Heart, Lung, and Blood Institute, relevant future initiatives include development of non-anticoagulant pharmacotherapies, effective implementation of weight loss, and risk factor modification, and designing successful programs for cardiac rehabilitation. As atrial fibrillation is a common arrhythmia, a lower incidence of complications may reduce the future economic costs in health care.”
AF improvements ‘beyond prevention of stroke’
In a related editorial, Jianhua Wu, PhD, professor of biostatistics and health data science at the Queen Mary University of London, and Ramesh Nadarajah, PhD, postdoctoral research fellow at the Institute of Data Analytics and Institute of Cardiovascular and Metabolic Medicine at the University of Leeds, U.K., discussed how the findings could inform future clinical trials and guidelines on AF management.
“The neglect of heart failure as a complication of atrial fibrillation in international guidelines is conspicuous because, similar to stroke, heart failure is associated with functional limitations, decreased quality of life and poor prognosis, and the subpopulation who have both atrial fibrillation and heart failure have a significantly increased risk of cardiovascular and all-cause mortality,” the authors wrote.
“Interventions to prevent stroke have dominated atrial fibrillation research and guidelines during the study period in Vinter and colleagues’ analysis, but no evidence suggests that these interventions can prevent incident heart failure,” they wrote. “Alignment of both randomized clinical trials and guidelines to better reflect the needs of the real-world population with atrial fibrillation is necessary because further improvements to patient prognosis are likely to require a broader perspective on atrial fibrillation management beyond prevention of stroke.”
References:
- Heart failure, not stroke is the most common complication of atrial fibrillation. https://www.eurekalert.org/news-releases/1041268. Published April 17, 2024. Accessed April 17, 2024.
- Wu J, et al. BMJ. 2024;doi:10.1136/bmj.q826.
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