Heart failure is the most common cardiovascular complication among patients with atrial fibrillation (AFib), according to new data published in The BMJ.[1] This may be a surprise to many, researchers said, because of how much attention is generally given to the relationship between AFib and stroke.
“Patients are commonly told that the main danger after being diagnosed with AFib is the increased risk of stroke, but AFib is associated with increased risk of other complications,” wrote first author Nicklas Vinter, a postdoctoral researcher with the Danish Center for Health Services Research in Denmark, and colleagues. “Quantification of the long-term downstream consequences of AFib will further improve our understanding of the burden of AFib and how to communicate risks to the public, but previous investigations do not appear to have addressed this question.”
Vinter et al. tracked 3.5 million Danish adults with no baseline history of AFib for a period of 23 years. All participants were between the ages of 45 and 95 years old, and 51.7% were women. Each participant was followed until “incident AFib, migration, death or end of follow-up, whichever came first.”
A total of 362,721 participants were ultimately diagnosed with AFib—53.6% were men—and they were each followed until a diagnosis of heart failure, stroke or myocardial infarction occurred. Reviewing the data, the group noted that the lifetime risk of atrial fibrillation appeared to increase from 24% in 2000-2010 to 31% in 2011-2022.
“The detection of AFib significantly improved over the past two decades, primarily due to advancements in technology, changes in clinical practice and increased awareness,” the authors wrote. “Approximately a third of patients with AFib are asymptomatic, and enhanced detection over time may lead to increased lifetime risk of diagnosed AFib. Another possible reason is the global increase in life expectancy.”
Meanwhile, AFib patients faced high lifetime risks of developing heart failure (41%) or experiencing a stroke (21%). The lifetime risk of an AFib patient suffering a myocardial infarction was 12%.
“Our findings encourage greater attention to secondary prevention of heart failure after AFib, and in line with a recent report from the National Heart, Lung, and Blood Institute, relevant future initiatives include development of non-anticoagulant pharmacotherapies, effective implementation of weight loss and risk factor modification, and designing successful programs for cardiac rehabilitation. As AFib is a common arrhythmia, a lower incidence of complications may reduce the future economic costs in healthcare.”
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Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.