Comparative thromboembolic risk in atrial fibrillation with and without a secondary precipitant-Danish nationwide cohort study
Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
Standard
Comparative thromboembolic risk in atrial fibrillation with and without a secondary precipitant-Danish nationwide cohort study. / Gundlund, A.; Kümler, Thomas; Bonde, Anders Nissen; Butt, Jawad Haider; Gislason, Gunnar Hilmar; Torp-Pedersen, Christian; Køber, Lars; Olesen, Jonas Bjerring; Fosbøl, Emil Loldrup.
I: BMJ Open, Bind 9, Nr. 9, e028468, 2019.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
Harvard
APA
Vancouver
Author
Bibtex
}
RIS
TY - JOUR
T1 - Comparative thromboembolic risk in atrial fibrillation with and without a secondary precipitant-Danish nationwide cohort study
AU - Gundlund, A.
AU - Kümler, Thomas
AU - Bonde, Anders Nissen
AU - Butt, Jawad Haider
AU - Gislason, Gunnar Hilmar
AU - Torp-Pedersen, Christian
AU - Køber, Lars
AU - Olesen, Jonas Bjerring
AU - Fosbøl, Emil Loldrup
PY - 2019
Y1 - 2019
N2 - Objectives We compared long-term outcomes in patients with atrial fibrillation (AF) with and without a secondary precipitant. Design and setting Retrospective cohort study based on Danish nationwide registries. Participants Patients with AF with and without secondary precipitants (1996-2015) were matched 1:1 according to age, sex, calendar year, CHA 2 DS 2-VASc score and oral anticoagulation therapy (OAC), resulting in a cohort of 39 723 patients with AF with a secondary precipitant and the same number of patients with AF without a secondary precipitant. Secondary precipitants included alcohol intoxication, thyrotoxicosis, myocardial infarction, surgery and infection in conjunction with AF. Primary and secondary outcomes The primary outcome in this study was thromboembolic events. Secondary outcomes included AF rehospitalisation and death. Long-term risks of outcomes were examined by multivariable Cox regression analysis. Results The most common precipitants were infection (55.0%), surgery (13.2%) and myocardial infarction (12.0%). The 5-year absolute risk of thromboembolic events (taking death into account as a competing risk) in patients with AF grouped according to secondary precipitants were 8.3% (alcohol intoxication), 8.5% (thyrotoxicosis), 12.1% (myocardial infarction), 11.6% (surgery), 12.2% (infection), 10.1% (>1 precipitant) and 12.3% (no secondary precipitant). In the multivariable analyses, AF with a secondary precipitant was associated with the same or an even higher thromboembolic risk than AF without a secondary precipitant. One exception was patients with AF and thyrotoxicosis: those not initiated on OAC therapy carried a lower thromboembolic risk the first year of follow-up than matched patients with AF without a secondary precipitant and no OAC therapy. Conclusions In general, AF with a secondary precipitant was associated with the same thromboembolic risk as AF without a secondary precipitant. Consequently, this study highlights the need for more research regarding the long-term management of patients with AF associated with a secondary precipitant.
AB - Objectives We compared long-term outcomes in patients with atrial fibrillation (AF) with and without a secondary precipitant. Design and setting Retrospective cohort study based on Danish nationwide registries. Participants Patients with AF with and without secondary precipitants (1996-2015) were matched 1:1 according to age, sex, calendar year, CHA 2 DS 2-VASc score and oral anticoagulation therapy (OAC), resulting in a cohort of 39 723 patients with AF with a secondary precipitant and the same number of patients with AF without a secondary precipitant. Secondary precipitants included alcohol intoxication, thyrotoxicosis, myocardial infarction, surgery and infection in conjunction with AF. Primary and secondary outcomes The primary outcome in this study was thromboembolic events. Secondary outcomes included AF rehospitalisation and death. Long-term risks of outcomes were examined by multivariable Cox regression analysis. Results The most common precipitants were infection (55.0%), surgery (13.2%) and myocardial infarction (12.0%). The 5-year absolute risk of thromboembolic events (taking death into account as a competing risk) in patients with AF grouped according to secondary precipitants were 8.3% (alcohol intoxication), 8.5% (thyrotoxicosis), 12.1% (myocardial infarction), 11.6% (surgery), 12.2% (infection), 10.1% (>1 precipitant) and 12.3% (no secondary precipitant). In the multivariable analyses, AF with a secondary precipitant was associated with the same or an even higher thromboembolic risk than AF without a secondary precipitant. One exception was patients with AF and thyrotoxicosis: those not initiated on OAC therapy carried a lower thromboembolic risk the first year of follow-up than matched patients with AF without a secondary precipitant and no OAC therapy. Conclusions In general, AF with a secondary precipitant was associated with the same thromboembolic risk as AF without a secondary precipitant. Consequently, this study highlights the need for more research regarding the long-term management of patients with AF associated with a secondary precipitant.
KW - recurrence
KW - reversible atrial fibrillation
KW - secondary precipitant
U2 - 10.1136/bmjopen-2018-028468
DO - 10.1136/bmjopen-2018-028468
M3 - Journal article
C2 - 31542739
AN - SCOPUS:85072586477
VL - 9
JO - BMJ Open
JF - BMJ Open
SN - 2044-6055
IS - 9
M1 - e028468
ER -
ID: 236273849