Abstract
BackgroundAtrial fibrillation can be categorized into nonpermanent and permanent atrial fibrillation. There is less information on permanent than on nonpermanent atrial fibrillation patients. This analysis aimed to describe the characteristics and current management, including the proportion of patients with successful atrial fibrillation control, of these atrial fibrillation subsets in a large, geographically diverse contemporary sample.Methods and ResultsData from RealiseAF, an international, observational, cross-sectional survey of 10,491 patients with atrial fibrillation, were used to characterize permanent atrial fibrillation (N = 4869) and nonpermanent atrial fibrillation (N = 5622) patients. Permanent atrial fibrillation patients were older, had a longer time since atrial fibrillation diagnosis, a higher symptom burden, and were more likely to be physically inactive. They also had a higher mean (SD) CHADS2 score (2.2 [1.3] vs. 1.7 [1.3], p<0.001), and a higher frequency of CHADS2 score ≥2 (67.3% vs. 53.0%, p<0.001) and comorbidities, most notably heart failure. Physicians indicated using a rate-control strategy in 84.2% of permanent atrial fibrillation patients (vs. 27.5% in nonpermanent atrial fibrillation). Only 50.2% (N = 2262/4508) of permanent atrial fibrillation patients were controlled. These patients had a longer time since atrial fibrillation diagnosis, a lower symptom burden, less obesity and physical inactivity, less severe heart failure, and fewer hospitalizations for acute heart failure than uncontrolled permanent atrial fibrillation patients, but with more arrhythmic events. The most frequent causes of hospitalization in the last 12 months were acute heart failure and stroke.ConclusionPermanent atrial fibrillation is a high-risk subset of atrial fibrillation, representing half of all atrial fibrillation patients, yet rate control is only achieved in around half. Since control is associated with lower symptom burden and heart failure, adequate rate control is an important target for improving the management of permanent atrial fibrillation patients.
Highlights
Atrial fibrillation (AF) is associated with substantial morbidity and mortality, as well as having a negative impact on quality of life and exercise capacity compared to the general population [1]
A retrospective analysis of the AFFIRM trial demonstrated that patients in sinus rhythm at the end of follow-up had improved outcomes compared to patients with AF [9]
permanent AF (PermAF) patients had a greater prevalence of AF-related symptoms (EHRA Classes III and IV 22.4% and 2.4%, respectively) compared with nonPermAF patients (18.1% and 1.6%, respectively), and had more CV risk factors than patients with nonPermAF (p = 0.016)
Summary
Atrial fibrillation (AF) is associated with substantial morbidity and mortality, as well as having a negative impact on quality of life and exercise capacity compared to the general population [1]. The 2006 ESC guidelines for AF management distinguished three types of AF: paroxysmal AF, persistent AF, and permanent AF (PermAF) [4]. Because the management of AF has historically focused on the restoration and maintenance of sinus rhythm, there is considerably less information regarding PermAF than nonPermAF. A retrospective analysis of the AFFIRM trial demonstrated that patients in sinus rhythm at the end of follow-up had improved outcomes compared to patients with AF [9]. There is less information on permanent than on nonpermanent atrial fibrillation patients. This analysis aimed to describe the characteristics and current management, including the proportion of patients with successful atrial fibrillation control, of these atrial fibrillation subsets in a large, geographically diverse contemporary sample
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