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Abstract
Purpose: Atrial fibrillation (AF) burden and type of AF have not been established as major differential predictors of stroke and death. The aim of this work was to analyse outcomes by type of AF and by antithrombotic therapy. Methods: 28,628 adults (≥18 yrs) with nonvalvular AF and ≥1 investigator-defined stroke risk factor were enrolled in the ongoing, prospective GARFIELD-AF registry from 32 countries in Mar 2010–Oct 2014. Patients classified as having paroxysmal (n=10,473, 48.5%), persistent (n=6020, 27.9%), or permanent AF (n=5117, 23.7%) by 4 mos were included in the analysis of baseline characteristics, antithrombotic therapy, and 2yr incidence of outcomes. Results: Patients with permanent AF had slightly higher CHA2DS2-VASc (3.5 vs both 3.1) and HAS-BLED (1.6 vs both 1.4) vs those with paroxysmal or persistent AF, and they were most likely to be ≥75 yrs (48.3% vs 33.6% vs 34.3%). Compared to patients with other AF types, those with paroxysmal AF were less likely to be obese (26.7% vs 30.9% vs 33.2%) or to have LVEF<40% (6.0% vs 12.0% vs 14.4%) or severe HF (NYHA Class III/IV; 25.3% vs 33.0% vs 38.8%), but they were as likely to have history of vascular disease: stroke/transient ischaemic attack 12.2% vs 10.7% vs 13.5%; carotid occlusive disease 2.9% vs 2.8% vs 4.1%; ACS 9.4% vs 8.3% vs 9.6%. Patients with paroxysmal AF were less likely to receive anticoagulant (AC) therapy (±antiplatelets, AP) vs those with persistent or permanent AF and more likely to receive AP only or no antithrombotics (Tab). Compared to patients with paroxysmal AF, those with persistent or permanent AF had higher risks of all-cause mortality, stroke/systemic embolism (SE) and major bleeding. However, only the difference in mortality persisted after adjustment (Fig). Adjusted HRs also showed higher mortality for non-paroxysmal vs paroxysmal AF and for permanent vs paroxysmal/persistent AF (Fig). We found no interaction between type of AF and AC therapy.
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