Heart rate is associated with progression of atrial fibrillation, independent of rhythm. Issue 11 (2nd March 2015)

• Record Type: Journal Article
• Authors: Holmqvist, Fredrik; Kim, Sunghee; Steinberg, Benjamin A; Reiffel, James A; Mahaffey, Kenneth W; Gersh, Bernard J; Fonarow, Gregg C; Naccarelli, Gerald V; Chang, Paul; Freeman, James V; Kowey, Peter R; Thomas, Laine; Peterson, Eric D; Piccini, Jonathan P
• Is Part Of: Heart. Volume 101:Issue 11(2015)
• Page Start: 894
• Page End: 899
• Publication Date: 2015-03-02
• Subjects: Heart -- Diseases -- Treatment -- Periodicals; Cardiology -- Periodicals; 616.12
• DOI: 10.1136/heartjnl-2014-307043
• Languages: English
• ISSNs: 1355-6037

Abstract

Abstract : Objective: Atrial fibrillation (AF) often progresses from paroxysmal or persistent to more sustained forms, but the rate and predictors of AF progression in clinical practice are not well described. Methods: Using the Outcomes Registry for Better Informed Treatment of AF, we analysed the incidence and predictors of progression and tested the discrimination and calibration of the HATCH ( h ypertension, a ge, T IA/stroke, c hronic obstructive pulmonary disease, h eart failure) and CHA2 DS2 VASc scores for identifying AF progression. Results: Among 6235 patients with paroxysmal or persistent AF at baseline, 1479 progressed, during follow-up (median 18 (IQR 12–24) months). These patients were older and had more comorbidities than patients who did not progress (CHADS2 2.3±1.3 vs 2.1±1.3, p<0.0001). At baseline, patients with AF progression were more often on a rate control as opposed to a rhythm control strategy (66 vs 56%, p<0.0001) and had higher heart rate (72(64–80) vs 68(60–76) bpm, p<0.0001). The strongest predictors of AF progression were AF on the baseline ECG (OR 2.30, 95% CI 1.95 to 2.73, p<0.0001) and increasing age (OR 1.16, 95% CI1.09 to 1.24, p<0.0001, per 10 increase), while patients with lower heart rate (OR 0.84, 95% CI 0.79 to 0.89, p<0.0001, per 10 decrease ≤80) were less likely to progress. There was no significant interaction between rhythm on baseline ECG and heart rate (p=0.71). The HATCH and CHA2 DS2 VASc scores had modest discriminatory power for AF progression (C-indices 0.55 (95% CI 0.53 to 0.58) and 0.55 (95% CI 0.52 to 0.57)). Conclusions: Within 1.5 years, almost a quarter of the patients with paroxysmal or persistent AF progress to a more sustained form. Progression is strongly associated with heart rate, and age.