Understanding the incidence of atrial fibrillation and stroke in hypertrophic cardiomyopathy patients: insights from Danish nationwide registries
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Understanding the incidence of atrial fibrillation and stroke in hypertrophic cardiomyopathy patients : insights from Danish nationwide registries. / Zörner, Christopher R; Schjerning, Anne-Marie; Jensen, Morten Kvistholm; Christensen, Alex Hørby; Tfelt-Hansen, Jacob; Tønnesen, Jacob; Riis-Vestergaard, Lise Da; Middelfart, Charlotte; Rasmussen, Peter Vibe; Gislason, Gunnar; Hansen, Morten Lock.
In: Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, Vol. 26, No. 7, 02.07.2024.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Understanding the incidence of atrial fibrillation and stroke in hypertrophic cardiomyopathy patients
T2 - insights from Danish nationwide registries
AU - Zörner, Christopher R
AU - Schjerning, Anne-Marie
AU - Jensen, Morten Kvistholm
AU - Christensen, Alex Hørby
AU - Tfelt-Hansen, Jacob
AU - Tønnesen, Jacob
AU - Riis-Vestergaard, Lise Da
AU - Middelfart, Charlotte
AU - Rasmussen, Peter Vibe
AU - Gislason, Gunnar
AU - Hansen, Morten Lock
N1 - © The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.
PY - 2024/7/2
Y1 - 2024/7/2
N2 - AIMS: The treatment of atrial fibrillation (AF) in hypertrophic cardiomyopathy (HCM) can be challenging since AF aggravates symptoms and increases the risk of stroke. Which factors contribute to the development of AF and stroke in HCM remains unknown. The aim of this study was to determine the incidence of AF and stroke in HCM patients and identify the risk factors.METHODS AND RESULTS: Using Danish national registries, all HCM patients from 2005 to 2018 were included. The association between HCM, incident AF, and stroke was investigated using multivariable Cox proportional hazards analysis. Cumulative incidences were calculated using the Aalen-Johansen estimator. Among the 3367 patients without prevalent AF, 24% reached the endpoint of incident AF with death as a competing risk. Median follow-up time was 4 years. Atrial fibrillation incidence was equal between sexes and increased for patients with ischaemic heart disease [IHD; hazard ratio (HR) 1.33, 95% confidence interval (CI) 1.08-1.63], hypertension (HT) (HR 1.36, 95% CI 1.14-1.67), and obstructive HCM (HR 1.27, 95% CI 1.05-1.52). Seven per cent developed stroke, with no difference detected stratifying for the presence of AF. Sub-analysis revealed that when AF was treated with oral anticoagulants (OACs), stroke was less likely (HR 0.4, 95% CI 0.18-0.86, P = 0.02). However, 34% of patients were not receiving adequate anticoagulation following AF diagnosis.CONCLUSION: Obstructive HCM, HT, and IHD were associated with increased risk of AF. Prevalent AF alone was not predictive of stroke; however, AF patients treated with OAC were significantly less likely to develop stroke, suggesting that this development is driven by the protective effect of OAC. Despite this, 34% of patients did not receive OAC.
AB - AIMS: The treatment of atrial fibrillation (AF) in hypertrophic cardiomyopathy (HCM) can be challenging since AF aggravates symptoms and increases the risk of stroke. Which factors contribute to the development of AF and stroke in HCM remains unknown. The aim of this study was to determine the incidence of AF and stroke in HCM patients and identify the risk factors.METHODS AND RESULTS: Using Danish national registries, all HCM patients from 2005 to 2018 were included. The association between HCM, incident AF, and stroke was investigated using multivariable Cox proportional hazards analysis. Cumulative incidences were calculated using the Aalen-Johansen estimator. Among the 3367 patients without prevalent AF, 24% reached the endpoint of incident AF with death as a competing risk. Median follow-up time was 4 years. Atrial fibrillation incidence was equal between sexes and increased for patients with ischaemic heart disease [IHD; hazard ratio (HR) 1.33, 95% confidence interval (CI) 1.08-1.63], hypertension (HT) (HR 1.36, 95% CI 1.14-1.67), and obstructive HCM (HR 1.27, 95% CI 1.05-1.52). Seven per cent developed stroke, with no difference detected stratifying for the presence of AF. Sub-analysis revealed that when AF was treated with oral anticoagulants (OACs), stroke was less likely (HR 0.4, 95% CI 0.18-0.86, P = 0.02). However, 34% of patients were not receiving adequate anticoagulation following AF diagnosis.CONCLUSION: Obstructive HCM, HT, and IHD were associated with increased risk of AF. Prevalent AF alone was not predictive of stroke; however, AF patients treated with OAC were significantly less likely to develop stroke, suggesting that this development is driven by the protective effect of OAC. Despite this, 34% of patients did not receive OAC.
KW - Humans
KW - Atrial Fibrillation/epidemiology
KW - Cardiomyopathy, Hypertrophic/epidemiology
KW - Male
KW - Female
KW - Denmark/epidemiology
KW - Registries
KW - Incidence
KW - Middle Aged
KW - Stroke/epidemiology
KW - Risk Factors
KW - Aged
KW - Adult
KW - Risk Assessment
U2 - 10.1093/europace/euae177
DO - 10.1093/europace/euae177
M3 - Journal article
C2 - 38917047
VL - 26
JO - Europace
JF - Europace
SN - 1099-5129
IS - 7
ER -
ID: 398711055