A population-based study of the long-term risks associated with atrial fibrillation: 20-year follow-up of the Renfrew/Paisley study

• Published in: The American journal of medicine Vol. 113; no. 5; pp. 359 - 364
• Main Authors: Stewart, Simon, Hart, Carole L, Hole, David J, McMurray, John J.V
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.10.2002; Elsevier; Elsevier Sequoia S.A
• Subjects: Atrial fibrillation; Atrial Fibrillation - complications; Atrial Fibrillation - mortality; Atrial Fibrillation - physiopathology; Biological and medical sciences; Cardiac arrhythmia; Cardiac dysrhythmias; Cardiology. Vascular system; Cardiovascular Diseases - complications; Cardiovascular Diseases - mortality; Cardiovascular Diseases - physiopathology; Cohort Studies; Epidemiology; Female; Follow-Up Studies; Health risk assessment; Heart; Heart failure; Humans; Male; Medical sciences; Middle Aged; Morbidity; Mortality; Outcome Assessment (Health Care); Prognosis; Proportional Hazards Models; Risk Factors; Scotland - epidemiology; Stroke; Survival Rate; Time Factors; Women; United Kingdom; Scotland; Great Britain; Europe; Heart failure; Stroke; Prognosis; Epidemiology; Atrial fibrillation; Morbidity; Arrhythmia; Infarct; Cardiovascular disease; Male; Myocardial disease; Vascular disease; Heart disease; Cohort study; Complication; Female; Cerebrovascular disease; Human; Nervous system diseases; Mortality; Coronary heart disease; Long term; Excitability disorder; Cerebral disorder; Central nervous system disease; Myocardium
• ISSN: 0002-9343; 1555-7162
• DOI: 10.1016/S0002-9343(02)01236-6

To describe the effect of atrial fibrillation on long-term morbidity and mortality. The Renfrew/Paisley Study surveyed 7052 men and 8354 women aged 45–64 years between 1972 and 1976. All hospitalizations and deaths occurring during the subsequent 20 years were analyzed by the presence or absence of atrial fibrillation at baseline. Lone atrial fibrillation was defined in the absence of other cardiovascular signs or symptoms. Cox proportional hazards models were used to adjust for age and cardiovascular conditions. After 20 years, 42 (89%) of the 47 women with atrial fibrillation had a cardiovascular event (death or hospitalization), compared with 2276 (27%) of the 8307 women without this arrhythmia. Among men, 35 (66%) of 53 with atrial fibrillation had an event, compared with 3151 (45%) of 6999 without atrial fibrillation. In women, atrial fibrillation was an independent predictor of cardiovascular events (rate ratio [RR] = 3.0; 95% confidence interval [CI]: 2.1–4.2), fatal or nonfatal strokes (RR = 3.2; 95% CI: 1.0–5.0), and heart failure (RR = 3.4; 95% CI: 1.9–6.2). The rate ratios among men were 1.8 (95% CI: 1.3–2.5) for cardiovascular events, 2.5 (95% CI: 1.3–4.8) for strokes, and 3.4 (95% CI: 1.7–6.8) for heart failure. Atrial fibrillation was an independent predictor of all-cause mortality in women (RR = 2.2; 95% CI: 1.5–3.2) and men (RR = 1.5; 95% CI: 1.2–2.2). However, lone atrial fibrillation (which occurred in 15 subjects) was not associated with a statistically significant increase in either cardiovascular events (RR = 1.5; 95% CI: 0.6–3.6) or mortality (RR = 1.8; 95% CI: 0.9–3.8). Atrial fibrillation is associated with an increased long-term risk of stroke, heart failure, and all-cause mortality, especially in women.