Atrial Fibrillation and Cardiovascular Comorbidities, Survival and Mortality: A Real-Life Observational Study

Jose Luis Clua-Espuny, Anna Panisello-Tafalla, Carlos Lopez-Pablo, Inigo Lechuga-Duran, Ramon Bosch-Princep, Jorgina Lucas-Noll, Antonia Gonzalez-Henares, Lluisa Queralt-Tomas, Rosa Ripolles-Vicente, Cristina Calduch-Noll, Nuria Gonzalez-Rojas, Miguel Gallofre-Lopez, Jose Luis Clua-Espuny, Anna Panisello-Tafalla, Carlos Lopez-Pablo, Inigo Lechuga-Duran, Ramon Bosch-Princep, Jorgina Lucas-Noll, Antonia Gonzalez-Henares, Lluisa Queralt-Tomas, Rosa Ripolles-Vicente, Cristina Calduch-Noll, Nuria Gonzalez-Rojas, Miguel Gallofre-Lopez

Abstract

Background: Atrial fibrillation (AF) is the most common cardiac tachyarrhythmia encountered in clinical practice affecting up to 10% of the population over 60 years old and its prevalence rises with age. The main goals were to characterize the AF patient population after the initial diagnosis of AF and to determine overall survival.

Methods: It is a real-life observational study of 269 subjects with an AF diagnosis over 60 years old randomly selected. The collected variables were: sociodemographic, cardiovascular complications/comorbidities (CVCs) included in the CHA2DS2-VASc and HAS_BLED scores, drug assigned as clinical treatment, mean range INR and CVCs and death dates (all-cause mortality). The survival curve and the risk of death were assessed using Kaplan-Meier survival curve and comparisons with log-rank.

Results: The average following time was 6.2 ± 3.7 years (0.2-20.4). Eleven point five percent died. Sixty-five point four percent had some CVCs. There were no differences in the overall incidence of CVCs by gender. The survival probability was 0.86 ± DE 0.03 among men and 0.90 ± DE 0.04 among women without differences. Thirty-six point eight percent (95% CI: 30.8 - 42.7) were diagnosed vascular complications before AF diagnosis, being ischemic cardiopathy (24.2%) and ischemic stroke (23.2%) the most frequent. The mortality is higher (P < 0.036) among those who suffered ≥ 3 vascular complications and significantly lower among those treated with statins (P = 0.032). After AF diagnosis, the most frequent was the cardiac heart failure (46.7%), significantly higher among women (P = 0.037). The mortality is significantly lower in those treated with OAC (P = 0.003).

Conclusions: AF is associated with ischemic heart disease, ischemic stroke and congestive heart failure, but the average mortality age is not different from the global population in Spain and Catalonia.

Keywords: Atrial fibrillation; Cardiovascular complication; Incidence; Mortality; Survival.

Figures

Figure 1
Figure 1
Longitudinal relationship between cardiovascular complications and atrial fibrillation. *Vascular complication.
Figure 2
Figure 2
Survival curve in patients with > 2 diagnosed CVC.
Figure 3
Figure 3
Survival curve and treatment with oral anticoagulant agents.
Figure 4
Figure 4
Survival curve in AF patients without CVC.
Figure 5
Figure 5
Survival curve to 5 years after AF diagnosis.

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