OA Epidemiology

New-Onset Atrial Fibrillation and Long-Term Risk of Heart Failure in the General Population: The Rotterdam Study

Proceedings of the 2013 annual meeting of the Netherlands Epidemiology Society

Volume 1 Issue S1 Abstract 36

 

M.J.G. Leening, Erasmus University Medical Center, Rotterdam, the Netherlands
J. Heeringa, Erasmus University Medical Center, Rotterdam, the Netherlands
B.P. Krijthe, Erasmus University Medical Center, Rotterdam, the Netherlands
J.W. Deckers, Erasmus University Medical Center, Rotterdam, the Netherlands
O.H. Franco, Erasmus University Medical Center, Rotterdam, the Netherlands
A. Hofman, Erasmus University Medical Center, Rotterdam, the Netherlands
J.W. Roos-Hesselink, Erasmus University Medical Center, Rotterdam, the Netherlands
J.C.M. Witteman, Erasmus University Medical Center, Rotterdam, the Netherlands
B.H.Ch. Stricker, Erasmus University Medical Center, Rotterdam; Health Care Inspectorate, the Hague, the Netherlands

Background
Limited data exist on the role of atrial fibrillation (AF – a sustained cardiac arrhythmia) in the development of heart failure in the general population. Our objective was to evaluate the long-term risk of heart failure associated with new-onset AF and compare  this to risks associated with other common chronic cardiac conditions, such as coronary heart disease (CHD).

Methods
Within the Rotterdam Study, a prospective population-based cohort, we followed 6,178 persons without heart disease at baseline for the occurrence of AF, CHD, and heart failure. We used multivariate adjusted time-dependent Cox-models to study the effect of newly- diagnosed AF on heart failure.

Results
During a median 14.2 years of follow-up,  584 diagnoses of AF were made and 994 participants developed heart failure. New-onset AF was associated with an increased risk of heart failure  (HR 3.16 [95%CI: 2.63-3.79]), which persisted after modeling a 5-year time-lag after AF diagnosis (HR 2.60 [95%CI: 1.88-3.58]) in order to ascertain that the diagnosis of AF preceded heart failure symptoms. The presence of AF only, CHD only, and concomitant AF and CHD showed  a gradual  increase in heart failure risk (HRs 3.52 [95%CI: 2.85-4.34], 4.30 [95%CI: 3.40-5.45], and 6.23 [95%CI: 3.56-10.88],  respectively). Population attributable risks were 12.2% for AF and 6.3% for CHD.

Conclusions
New-onset AF was a strong risk factor for heart failure in the general population, with long- term risks close to those of CHD. Persons with AF may well constitute an important part of the general population that could benefit from preventive measures to reduce the growing burden of chronic heart failure.

Published: 06 Jun, 2013

 
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