Abstract 14719: Prognostic Implications of Traditional and Non-traditional Cardiovascular Risk Factor Profiles in Patients With Non-valvular Atrial Fibrillation

Abstract

Introduction: Atrial fibrillation (AF) is a prevalent disease with an associated mortality risk, mediated in large part through its associated cardiovascular risk factors. Standard Modifiable Cardiovascular Risk Factors (SMuRFs; hypercholesterolaemia, hypertension, diabetes and smoking) are established drivers of cardiovascular disease, however the importance of non-traditional mediators of cardiovascular risk such as chronic renal impairment, obstructive sleep apnoea and obesity (NTRFs) is emerging in the literature. The differential impact of these risk factor groups on outcomes in patients with AF is not well studied. Hypothesis: SMuRFs and emerging NTRFs will have a differential impact on prognosis in patients with AF. Methods: Consecutive patients admitted to our service between 2013-2017 with a primary diagnosis of non-valvular AF were assessed. The clinical course of these patients was followed for up to five years for the composite outcome of all-cause death and major adverse cardiovascular events. We excluded patients with valvular AF, incomplete clinical data and baseline comorbid conditions limiting lifespan to <6 months. Results: Of the 1010 patients (62.29±16.81 years, 52% men) included, 154 (15.2%) had no risk factors, 478 (47.3%) had only SMuRFs, 59 (5.8%) had only NTRFs and 319 (31.6%) had both SMuRFs and NTRFs. Over a mean follow-up period of 33.18±21.27 months, a total of 288 patients met the composite outcome. On log rank tests, grouping of risk factor profiles was a significant predictor of the composite outcome (see Kaplan Meier curve). On multi-variable analysis, the coexistence of SMuRFs and NTRFs was an independent predictor of the composite outcome (HR 1.40; 95%CI 1.09-1.82, p=0.01). Other independent predictors included age, heart failure, CHA2DS2VASc score, persistent AF and anaemia. Conclusions: Presence of both traditional and emerging NTRFs has prognostic implications in patients with AF.