Pattern of atrial fibrillation and risk of outcomes: the Loire Valley Atrial Fibrillation Project
Abstract
Background Risk of stroke and thromboembolism (TE) in patients with non-valvular atrial fibrillation (NVAF) is categorised in stroke risk stratification scores. The role of pattern of NVAF in risk prediction is unclear in contemporary 'real world' cohorts.Methods and results Patients with NVAF in a four-hospital-institution between 2000 and 2010 were included. Stroke/TE event rates were calculated according to pattern of AF, i.e. paroxysmal, persistent and permanent. Risk factors were investigated by Cox regression. Among 7156 NVAF patients, 4176 (58.4%) patients with paroxysmal, 376 (5.3%) with persistent and 2604 (36.3%) with permanent patterns of NVAF were included. In non-anticoagulated patients, overall stroke/TE event rate per 100 person-years was 1.29 (95% CI 1.13-1.47). Compared with paroxysmal NVAF, rates of stroke/TE, bleeding and all-cause mortality (p<0.001) were significantly higher in permanent NVAF patients but not in persistent NVAF patients. In multivariate analyses, previous stroke (hazard ratio, HR 2.58, 95% CI 2.08-3.21), vascular disease (HR 1.34, 1.12-1.61), heart failure (HR 1.20, 1.00-1.44), age ≥ 75 years (HR 2.75, 2.16-3.50) and age 65-74 years (HR 1.60, 1.22-2.09) independently increased stroke/TE risk, but not persistent (HR 1.13, 0.76-1.70) and permanent (HR 1.44, 0.96-2.16) NVAF patterns.Conclusion In this large 'real world' NVAF cohort, rates of stroke, TE, death and bleeding differed significantly by patterns of NVAF. However, only previous stroke, age, heart failure and vascular disease (not pattern of NVAF) independently increased risk of adverse outcomes in multivariate analyses. Thus, stroke risk is similar across all patterns of NVAF and antithrombotic therapy should be based on clinical risk factors, not on arrhythmia pattern.
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There is some evidence suggesting that AF burden may influence stroke risk.
“There is some evidence suggesting that AF burden may influence stroke risk 44,124,164 and could modify the response to rhythm control therapy.76,165”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [164]
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- Authors
- Banerjee, A., Taillandier, S., Olesen, J. B., Lane, D. A., Lallemand, B., Lip, G. Y. H., & Fauchier, L.
- Affiliations
- Birmingham City Hospital (GB)
- Université de Tours (FR)
- Corresponding author
- Banerjee, Amitava
- Taillandier, Sophie
- Olesen, Jonas Bjerring
- Lane, Deirdre A.
- Lip, Gregory Y.H.
- Fauchier, Laurent
- Venue
- International Journal of Cardiology
- Publisher
- Elsevier BV
- Published
- 2013-09
- Volume
- 167
- Issue
- 6
- Pages
- 2682-2687
- ISSN
- 0167-5273 (ISSN-L)
- OpenAlex
- W2068914982
- Cited by
- 87
- References
- 26
- Citations by year
- 2026: 8 · 2025: 7 · 2024: 4 · 2023: 2 · 2022: 5 · 2021: 7 · 2020: 9 · 2019: 4 · 2018: 8 · 2017: 7 · 2016: 11 · 2015: 4 · 2014: 6 · 2013: 5
- FWCI
- 3.09
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- International Journal of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- HAL (submittedVersion)
- UCL Discovery (University College London) (submittedVersion)
- University of Birmingham Research Portal (University of Birmingham) (submittedVersion)
- Funders
- AstraZeneca
- Boehringer Ingelheim
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cardiovascular and Diving-Related Complications
- Keywords
- atrial fibrillation, non-valvular atrial fibrillation, paroxysmal atrial fibrillation, persistent atrial fibrillation, permanent atrial fibrillation, stroke risk, thromboembolism, bleeding risk, all-cause mortality, stroke risk stratification, anticoagulation, heart failure, vascular disease, age, risk factors
- MeSH terms
- Aged, Aged, 80 and over, Atrial Fibrillation, Female, France, Humans, Male, Risk Factors, Thromboembolism, Cohort Studies, Treatment Outcome, Stroke
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