(Circulation. 1998;98:943-945.)
© 1998 American Heart Association, Inc.
Epidemiological and Mechanistic Studies of Atrial Fibrillation as a Basis for Treatment Strategies
J. Thomas Bigger, Jr, MD
From Columbia University, New York, NY.
Correspondence to J. Thomas Bigger, Jr, MD, Columbia University PH 103-D, 630 W 168th St, New York, NY 10032. E-mail jtb2@columbia.edu
Key Words: Editorials • fibrillation, atrial • prevention • hypertension • catheter ablation • stroke
In
this issue of Circulation, Benjamin et
al1 provide evidence from the Framingham cohort
that atrial fibrillation (AF) increases the mortality rate and that
this association persists when adjusted for age, hypertension, smoking,
diabetes, electrocardiographic left ventricular
hypertrophy, myocardial infarction, congestive heart
failure, valvular heart disease, and stroke or transient
ischemic attack. The current analysis showed that of
the 5209 residents of Framingham who originally enrolled in this
population study, 621 developed AF during follow-up. Participants who
developed AF were more likely to have hypertension, a smoking habit,
electrocardiographic left ventricular
hypertrophy, myocardial infarction, congestive heart
failure, valvular heart disease, and stroke or transient
ischemic attack at baseline. Echocardiographic
left atrial dimension was not available for analysis. The
age-adjusted odds ratios for death with AF were 2.4 for men and 3.5 for
women. After adjusting for risk factor status at each biennial
examination, the odds ratios for death were 1.5 for men and 1.9 for
women. Much of the excess death attributable to AF occurred soon after
diagnosis of AF, but after the first 30-day mortality experience was
excluded, there was still a significant association of AF with death
during follow-up. There was no interaction between age and AF for death
during follow-up; ie, AF increased the likelihood of dying at all
ages.
There was a significant interaction between AF and sex with
respect to mortality; the presence of AF substantially decreased the
survival advantage women usually have over men. The morbidity of
patients with AF is well known. . . . [Full Text of this Article]
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