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Heart rate is associated with progression of atrial fibrillation, independent of rhythm.

Publication ,  Journal Article
Holmqvist, F; Kim, S; Steinberg, BA; Reiffel, JA; Mahaffey, KW; Gersh, BJ; Fonarow, GC; Naccarelli, GV; Chang, P; Freeman, JV; Kowey, PR ...
Published in: Heart
June 2015

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 (hypertension, age, TIA/stroke, chronic obstructive pulmonary disease, heart failure) and CHA₂DS₂VASc 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 CHA₂DS₂VASc 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.

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Published In

Heart

DOI

EISSN

1468-201X

Publication Date

June 2015

Volume

101

Issue

11

Start / End Page

894 / 899

Location

England

Related Subject Headings

  • Risk Factors
  • Male
  • Hypertrophy, Left Ventricular
  • Humans
  • Heart Rate
  • Heart Failure
  • Female
  • Disease Progression
  • Cohort Studies
  • Cardiovascular System & Hematology
 

Citation

APA
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ICMJE
MLA
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Holmqvist, F., Kim, S., Steinberg, B. A., Reiffel, J. A., Mahaffey, K. W., Gersh, B. J., … ORBIT-AF Investigators, . (2015). Heart rate is associated with progression of atrial fibrillation, independent of rhythm. Heart, 101(11), 894–899. https://doi.org/10.1136/heartjnl-2014-307043
Holmqvist, Fredrik, Sunghee Kim, Benjamin A. Steinberg, James A. Reiffel, Kenneth W. Mahaffey, Bernard J. Gersh, Gregg C. Fonarow, et al. “Heart rate is associated with progression of atrial fibrillation, independent of rhythm.Heart 101, no. 11 (June 2015): 894–99. https://doi.org/10.1136/heartjnl-2014-307043.
Holmqvist F, Kim S, Steinberg BA, Reiffel JA, Mahaffey KW, Gersh BJ, et al. Heart rate is associated with progression of atrial fibrillation, independent of rhythm. Heart. 2015 Jun;101(11):894–9.
Holmqvist, Fredrik, et al. “Heart rate is associated with progression of atrial fibrillation, independent of rhythm.Heart, vol. 101, no. 11, June 2015, pp. 894–99. Pubmed, doi:10.1136/heartjnl-2014-307043.
Holmqvist F, Kim S, Steinberg BA, Reiffel JA, Mahaffey KW, Gersh BJ, Fonarow GC, Naccarelli GV, Chang P, Freeman JV, Kowey PR, Thomas L, Peterson ED, Piccini JP, ORBIT-AF Investigators. Heart rate is associated with progression of atrial fibrillation, independent of rhythm. Heart. 2015 Jun;101(11):894–899.

Published In

Heart

DOI

EISSN

1468-201X

Publication Date

June 2015

Volume

101

Issue

11

Start / End Page

894 / 899

Location

England

Related Subject Headings

  • Risk Factors
  • Male
  • Hypertrophy, Left Ventricular
  • Humans
  • Heart Rate
  • Heart Failure
  • Female
  • Disease Progression
  • Cohort Studies
  • Cardiovascular System & Hematology