Journal of Cardiovascular Pharmacology and Therapeutics (Jan 2022)

Associations of Atrial Fibrillation Patterns With Mortality and Cardiovascular Events: Implications of the MISOAC-AF Trial

  • Amalia Baroutidou MD,
  • Anastasios Kartas MD, MSc,
  • Athanasios Samaras MD,
  • Andreas S. Papazoglou MD,
  • Eleni Vrana MD,
  • Dimitrios V. Moysidis MD,
  • Evangelos Akrivos MSc,
  • Anastasios Papanastasiou MD, MSc,
  • Ioannis Vouloagkas MD,
  • Michail Botis MD,
  • Evangelos Liampas MD,
  • Artemios G. Karagiannidis MD,
  • Efstratios Karagiannidis MD, PhD,
  • Georgios Efthimiadis MD, PhD,
  • Haralambos Karvounis MD, PhD,
  • Apostolos Tzikas MD, PhD,
  • George Giannakoulas MD, PhD

DOI
https://doi.org/10.1177/10742484211069422
Journal volume & issue
Vol. 27

Abstract

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Aim: This retrospective cohort study aimed to evaluate the prognostic implications of the distinct atrial fibrillation (AF) temporal patterns: first diagnosed, paroxysmal, and persistent or permanent AF. Methods: In this post hoc analysis of the MISOAC-AF trial (NCT02941978), a total of 1052 patients with AF (median age 76 years), discharged from the cardiology ward between 2015 and 2018, were analyzed. Kaplan-Meier and Cox-regression analyses were performed to compare the primary outcome of all-cause mortality, the secondary outcomes of stroke, major bleeding and the composite outcome of cardiovascular (CV) mortality or hospitalization among AF patterns. Results: Of patients, 121 (11.2%) had first diagnosed, 356 (33%) paroxysmal, and 575 (53.2%) persistent or permanent AF. During a median follow-up of 31 months (interquartile range 10 to 52 months), 37.3% of patients died. Compared with paroxysmal AF, patients with persistent or permanent AF had higher mortality rates (adjusted hazard ratio (aHR), 1.37; 95% confidence interval [CI], 1.08-1.74, P = .009), but similar CV mortality or hospitalization rates (aHR, 1.09; 95% CI, 0.91-1.31, P = .35). Compared with first diagnosed AF, patients with persistent or permanent AF had similar mortality (aHR, 1.26; 95% CI, 0.87-1.82, P = .24), but higher CV mortality or hospitalization rates (aHR, 1.35; 95% CI, 1.01-1.8, P = .04). Stroke and major bleeding events did not differ across AF patterns (all P > .05). Conclusions: In conclusion, in recently hospitalized patients with comorbid AF, the presence of persistent or permanent AF was associated with a higher incidence of mortality and morbidity compared with paroxysmal and first diagnosed AF.