Year: 2010
Type: dissertation
Abstract: Aim: To investigate temporal trends in the risk of mortality and stroke associated with incident\natrial fibrillation (AF) in Sweden. To investigate the risk of morbidity and mortality associated\nwith prevalent and incident AF in patients with chronic heart failure with preserved (CHF-PEF) or\nreduced left ventricular ejection fraction (CHF-REF) enrolled in two large randomised trials.\nMethods: In Papers I and II, we utilized Swedish National Hospital Discharge Registry linked\nwith the cause-specific death registers. The hospital discharge registry has been in operation since\nthe 1960s and has operated on a nation-wide basis since 1987. From this source all patients\ndischarged from a Swedish hospital with a first diagnosis of AF were collected, and data\nregarding age, gender and registered comorbidities were obtained and compared by 5-year\nperiods. Paper III utilized data from the Carvedilol Or Metoprolol European Trial (COMET).\nPaper IV utilized data from the Candesartan in Heart failure-Assessment of Reduction in\nMorbidity and mortality (CHARM) programme.\nResults: The incidence of ischemic strokes up to 3-years after a first diagnosis of AF was 11.6%\n1987-1991 (period 1) and 9.6% 2002-2006 (period 4), corresponding to a 17.5% relative decrease,\nthe decrease mainly occurred during 1997-2001 (period 3), with small changes before and\nthereafter. The incidence of hemorrhagic strokes was 1.0% period 1 and 1.3% period 4, a 37.2%\nrelative increase. The total number of strokes thus declined during the observation period. The\ndecline in the total stroke incidence in AF patients was higher than that seen in the rest of the\nSwedish population. 3-year mortality was 34% during period 1 and 26% period 4, corresponding\nto a 23% relative decrease in mortality during the observation period. Patients diagnosed with any\nof previous stroke, chronic heart failure, acute coronary syndrome and diabetes mellitus had high\nbut declining 3-year mortality rates during the observation period, regardless of age and sex.\nPatients without the prespecified comorbidities had lower case-fatality, especially in younger\npatients, but improvements in survival were smaller. Patients with CHF and AF had an increased\nrisk of mortality and morbidity compared to patients in sinus rhythm, regardless of LVEF at\nbaseline. Patients with CHF-REF had the highest absolute morbidity and mortality in CHARM\ntrial, but patients with CHF-PEF had higher relative increase in morbidity and mortality with AF.\nNew onset AF during the follow-up was a strong predictor of mortality and morbidity in both\nstudies, regardless of baseline LVEF.\nConclusions: Patients discharged from a Swedish hospital with a first diagnosis of atrial\nfibrillation had moderate decreases in stroke incidence and mortality during a 20 year observation\nperiod. Although treatment and management of AF and its associating conditions, have improved\ndramatically during the last 30 years, AF is still associated with an excess morbidity and\nmortality. Even when patients with important comorbidities are excluded from the analysis, there\nis a considerable mortality among patients with AF. In a prespecified analysis of two large\nrandomized trials with CHF and AF, AF was associated with increased morbidity and mortality\nboth when present and when occurring during study follow-up, regardless of baseline EF.\nKeywords: Atrial fibrillation, stroke, ischemic, hemorrhagic, mortality, temporal trends, ejection\nfraction, preserved, chronic heart failure, new onset, cohort study, randomised controlled trial.
Author: Lars Olsson
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2136951719