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Incidence of Atrial Fibrillation and Relationship With Cardiovascular Events, Heart Failure, and Mortality
Open accessAbstract
Background Important improvements have been made in treatment of diseases associated with atrial fibrillation (AF), such as hypertension, myocardial infarction, and heart failure. Incidence rates and risk factors may have changed with the aging of the population and changing lifestyles. Currently, the risk for AF is only partially explained, possibly because of differences between older cohorts and contemporary populations.Objectives This study investigated the incidence of AF in a contemporary cohort in the Netherlands, together with comorbidities associated with AF and associations of AF with cardiovascular outcomes.Methods Incident AF was ascertained for hospital and study electrocardiograms in 8,265 participants of the PREVEND (Prevention of Renal and Vascular End-Stage Disease) study in Groningen, the Netherlands.Results During 9.7 ± 2.3 years of follow-up, 265 participants developed AF, with a resulting overall AF incidence of 3.3 per 1,000 person-years. Advancing age, male sex, antihypertensive drug use, higher body mass index, previous myocardial infarction, and previous stroke were associated with AF. After multivariable adjustment, AF was associated with cardiovascular events (hazard ratio [HR]: 2.24; 95% confidence interval [CI]: 1.06 to 4.75; p = 0.035), heart failure with either reduced or preserved ejection fraction (HR: 4.52; 95% CI: 2.02 to 10.09; p < 0.001), and all-cause mortality (HR: 3.02; 95% CI: 1.73 to 5.27; p < 0.001).Conclusions The incidence of AF in the present cohort was comparable to that shown in data of older studies. Obesity has become a major risk factor for incident AF. Although overall cardiovascular event rates were lower in the present study, the present study confirms the association of incident AF with such events.
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“Obesity 19, 208 none (BMI < 25 kg/m²) overweight (BMI 25-30 kg/m²) obese (BMI ≥ 31 kg/m²) HR: 1.00 (reference) 1.13 (95% CI 0.87-1.46)1.37 (95% CI 1.05-1.78)”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [208]
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MethodAtrial fibrillation risk in metabolically healthy obesity: A nationwide population-based study
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“may differ by the proximity of their temporal relationship (5,10), we performed sensitivity analyses that censored HF events <30 days after AF diagnosis (n 1⁄4 61).”
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“3,4 Atrial fibrillation is an independent risk factor for heart failure and myocardial infarction 5,6 and is responsible for one in five strokes.”
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“Two independent observers manually assessed all ECGs of DTC patients, as well as all ECGs of controls with suspected AF during electronic ECG screening (21).”
MethodSerial galectin-3 and future cardiovascular disease in the general population
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Prevalence and incidence of diastolic dysfunction in atrial fibrillation: clinical implications
Naser, J. A., Lee, E., Scott, C. G., Kennedy, A. M., Pellikka, P. A., Lin, G., Pislaru, S. V., & Borlaug, B. A. (2023) · European Heart Journal · doi:10.1093/eurheartj/ehad592 · Cited by 53
Atrial fibrillation in young patients
Gourraud, J., Khairy, P., Abadir, S., Tadros, R., Cadrin‐Tourigny, J., Macle, L., Dyrda, K., Mondesert, B. A., Dubuc, M., Guerra, P. G., et al. (2018) · Expert Review of Cardiovascular Therapy · doi:10.1080/14779072.2018.1490644 · Cited by 50
“Increased risk of stroke, morbidity, and mortality associated with AF is well established in adults [4,27,128,129].”
BackgroundAriyaratnam, J., Elliott, A. D., Mishima, R. S., Gallagher, C., Lau, D. H., & Sanders, P. (2021) · Heart Rhythm O2 · doi:10.1016/j.hroo.2021.09.015 · Cited by 52
“8 times.(13) Similarly, the presence of AF increases the risk of HFpEF by 2.”
BackgroundHimmelreich, J. C. L., Lucassen, W. A. M., Harskamp, R. E., Aussems, C., van Weert, H. C. P. M., & Nielen, M. M. J. (2021) · Open Heart · doi:10.1136/openhrt-2020-001459 · Cited by 49
“The CHARGE-AF model We calculated each individual’s CHARGE-AF predicted 5-year AF risk using the formula from the original derivation article 5 The Dutch population is ~95% Caucasian/white, 19 and Nivel-PCD contains a representative sample of Dutch inhabitants.”
Cardiovascular health in adults with type 1 diabetes
McCarthy, M. M., Funk, M., & Grey, M. J. (2016) · Preventive Medicine · doi:10.1016/j.ypmed.2016.08.019 · Cited by 47
“In a large population-based cohort, the use of blood pressure medication was strongly associated with an increased risk of atrial fibrillation (Vermond et al., 2015).”
BackgroundTemporal trends of cause-specific mortality after diagnosis of atrial fibrillation
Wu, J., Nadarajah, R., Nakao, Y. M., Nakao, K., Wilkinson, C., Cowan, J. C., Camm, A. J., & Gale, C. P. (2023) · European Heart Journal · doi:10.1093/eurheartj/ehad571 · Cited by 47
“1,2,18 Other reports have described causes of death amongst randomized controlled trial populations, which may not be reflective of the real-world population with AF or routine practice.”
BackgroundHeart Failure in Atrial Fibrillation ― An Update on Clinical and Echocardiographic Implications ―
Taniguchi, N., Miyasaka, Y., Suwa, Y., Harada, S., Nakai, E., & Shiojima, I. (2020) · Circulation Journal · doi:10.1253/circj.cj-20-0258 · Cited by 43
Naser, J. A., Michelena, H. I., Lin, G., Scott, C. G., Lee, E., Kennedy, A. M., Noseworthy, P. A., Pellikka, P. A., Nkomo, V. T., & Pislaru, S. V. (2023) · European Heart Journal - Cardiovascular Imaging · doi:10.1093/ehjci/jead199 · Cited by 47
Chamberlain, A. M., Gersh, B. J., Alonso, Á., Kopecky, S. L., Killian, J. M., Weston, S. A., & Roger, V. L. (2017) · Heart Rhythm · doi:10.1016/j.hrthm.2017.01.031 · Cited by 41
Zylla, M. M., Leiner, J., Rahm, A., Hoffmann, T., Lugenbiel, P., Schweizer, P. A., Scholz, E., Mereles, D., Kronsteiner, D., Kieser, M., et al. (2022) · Circulation Heart Failure · doi:10.1161/circheartfailure.121.009281 · Cited by 40
Maat, G. E. D., Mulder, B. A., Berretty, W. L., Al-Jazairi, M. I. H., Tan, Y. E. S., Wiesfeld, A. C. P., Mariani, M. A., Gelder, I. C. V., Rienstra, M., & Blaauw, Y. (2018) · Open Heart · doi:10.1136/openhrt-2017-000771 · Cited by 40
“Animal models of obesity demonstrated increased levels of atrial fibrosis and higher susceptibility and sustainability of AF.”
BackgroundInfluentialHan, X., Yang, Y., Chen, Y., Gao, L., Yin, X., Li, H., Qiu, J., Wang, Y., Zhou, Y., & Xia, Y. (2017) · Clinical Cardiology · doi:10.1002/clc.22731 · Cited by 37
“AF is often accompanied by increased risks of ischemic stroke,(7) dementia,(8) heart failure,(9) and overall mortality.(9) Therefore, AF has a significant impact on patient quality of life, and early diagnosis and medical interventions targeting individuals who are at a high risk for AF may significantly reduce the co…”
BackgroundDing, W. Y., Harrison, S. L., Gupta, D., Lip, G. Y. H., & Lane, D. A. (2020) · Frontiers in Medicine · doi:10.3389/fmed.2020.00054 · Cited by 36
Wang, X., Hou, Y., Wang, X., Li, Z., Wang, X., Li, H., Shang, L., Zhou, J., Zhang, Y., Ren, M., et al. (2021) · Nutrition Metabolism and Cardiovascular Diseases · doi:10.1016/j.numecd.2021.05.034 · Cited by 35
Packer, M. (2019) · The American Journal of Medicine · doi:10.1016/j.amjmed.2019.08.027 · Cited by 33
van de Kar, M. R. D., van Brakel, T. J., Veer, M. V. ’., van Steenbergen, G. J., Daeter, E. J., Crijns, H. J. G. M., van Veghel, D., Dekker, L., & Otterspoor, L. (2024) · European Heart Journal · doi:10.1093/eurheartj/ehae267 · Cited by 32
The changing circumstance of atrial fibrillation ‐ progress towards precision medicine
Camm, A. J., Savelieva, I., Potpara, T., Hindriks, G., Pison, L., & Blomström‐Lundqvist, C. (2016) · Journal of Internal Medicine · doi:10.1111/joim.12478 · Cited by 30
Hobbelt, A. H., Siland, J. E., Geelhoed, B., van der Harst, P., Hillege, H. L., Gelder, I. C. V., & Rienstra, M. (2016) · EP Europace · doi:10.1093/europace/euw016 · Cited by 31
Reactive atrial‐based antitachycardia pacing therapy reduces atrial tachyarrhythmias
Crossley, G. H., Padeletti, L., ZWEIBEL, S. L., Hudnall, J. H., Zhang, Y., & Boriani, G. (2019) · Pacing and Clinical Electrophysiology · doi:10.1111/pace.13696 · Cited by 30
Marcos, E. G., Geelhoed, B., van der Harst, P., Bakker, S. J. L., Gansevoort, R. T., Hillege, H. L., Gelder, I. C. V., & Rienstra, M. (2016) · EP Europace · doi:10.1093/europace/euw373 · Cited by 30
“Individuals with AF are at increased risk for cardiovascular complications such as stroke, dementia, heart failure, and death.(2,3) Known risk factors and conditions associated with AF are advancing age, male sex, diabetes mellitus, hypertension, valve disease, myocardial infarction, heart failure, and obesity.”
Miyazawa, K., Pastori, D., Martin, D. T., Choucair, W. K., Halperin, J. L., Lip, G. Y. H., & the IMPACT Study Investigators (2021) · EP Europace · doi:10.1093/europace/euab186 · Cited by 28
“Atrial fibrillation (AF) is associated with increased risks of stroke, myocardial infarction, heart failure, and mortality.(1) A substantial proportion of AF is asymptomatic and often eludes detection by conventional diagnostic methods such as physical examination, 12-lead electrocardiogram (ECG), and 24-h Holter ECG.”
BackgroundGeng, T., Wang, Y., Lu, Q., Zhang, Y., Chen, J., Zhou, Y., Wan, Z., Guo, K., YANG, K. Y., Liu, L., et al. (2022) · Diabetes Care · doi:10.2337/dc22-0717 · Cited by 32
Atrial Fibrillation and Heart Failure: Untangling a Modern Gordian Knot
Skanes, A. C., & TANG, A. S. L. (2018) · Canadian Journal of Cardiology · doi:10.1016/j.cjca.2018.07.483 · Cited by 27
Kofler, T., Thériault, S., Bossard, M., Aeschbacher, S., Bernet, S., Krisai, P., Blum, S., Risch, M., Risch, L., Albert, C. M., et al. (2016) · Circulation Arrhythmia and Electrophysiology · doi:10.1161/circep.116.004735 · Cited by 27
Tachycardia and Atrial Fibrillation-Related Cardiomyopathies
Keefe, J. A., Garber, R., McCauley, M. D., & Wehrens, X. H. T. (2024) · JACC Heart Failure · doi:10.1016/j.jchf.2023.11.016 · Cited by 26
Atrial Fibrillation Genetics Update: Toward Clinical Implementation
Kalstø, S. M., Siland, J. E., Rienstra, M., & Christophersen, I. E. (2019) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2019.00127 · Cited by 28
Li, Y., Bai, J., Zhou, G., Li, J., Wei, Y., Sun, L., Zu, L., & Liu, S. (2021) · European Journal of Internal Medicine · doi:10.1016/j.ejim.2021.04.014 · Cited by 26
Nicoli, C. D., O’Neal, W. T., Levitan, E. B., Singleton, M. J., Judd, S. E., Howard, G., Safford, M. M., & Soliman, E. Z. (2021) · Heart · doi:10.1136/heartjnl-2021-319122 · Cited by 26
Atrial fibrillation risk factor management with a plant‐based diet: A review
Storz, M. A., & Helle, P. (2019) · Journal of Arrhythmia · doi:10.1002/joa3.12254 · Cited by 26
Multimorbidity in patients with atrial fibrillation
Lobeek, M., Middeldorp, M. E., Gelder, I. C. V., & Rienstra, M. (2024) · Open Heart · doi:10.1136/openhrt-2024-002641 · Cited by 26
“19 Numerous population-based investigations have explored the association between multimorbidity and AF.”
BackgroundRisk of Dementia After Smoking Cessation in Patients With Newly Diagnosed Atrial Fibrillation
Lee, H.-J., Lee, S., Choi, E., Park, S., Chung, J.-W., Choi, J., Han, M., Jung, J., Han, K., Oh, S., et al. (2022) · JAMA Network Open · doi:10.1001/jamanetworkopen.2022.17132 · Cited by 25
Miyazawa, K., Pastori, D., Li, Y., Székely, O., Shahid, F., Boriani, G., & Lip, G. Y. H. (2019) · Clinical Research in Cardiology · doi:10.1007/s00392-019-01432-y · Cited by 25
Ding, W. Y., Proietti, M., Romiti, G. F., Vitolo, M., Fawzy, A. M., Boriani, G., Marín, F. R., Blomström‐Lundqvist, C., Potpara, T., Fauchier, L., et al. (2022) · European Journal of Internal Medicine · doi:10.1016/j.ejim.2022.11.004 · Cited by 24
Abrahamyan, L., Barker, M., Dharma, C., Lee, D. S., Austin, P. C., Asghar, A., Muthuppalaniappan, A. M., Benson, L. N., Osten, M., & Horlick, E. M. (2022) · International Journal of Cardiology · doi:10.1016/j.ijcard.2022.09.033 · Cited by 23
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Yang, Y., Han, X., Chen, Y., Gao, L., Yin, X., Li, H., Qiu, J., Wang, Y., Zhou, Y., & Xia, Y. (2017) · Clinical Cardiology · doi:10.1002/clc.22771 · Cited by 21
“Atrial fibrillation (AF) is the most common arrhythmia in the clinic, and comorbidities with AF have been associated with an increased risk of morbidity and mortality.(1) AF may cause many fatal complications such as thromboembolic events and heart failure.”
BackgroundXu, C., Li, H., Yang, J., Peng, Y., Cai, H., Zhou, J., Gu, W., & Chen, L. (2023) · BMC Medical Informatics and Decision Making · doi:10.1186/s12911-023-02371-5 · Cited by 22
“After gathering a total of 1222 individuals with CHF brought on by various forms of cardiovascular illness, we were able to identify 626 patients who had been followed up for more than three years or had passed away [21].”
BackgroundNaser, N., Kulić, M., Dilić, M., Džubur, A., Durak-Nalbantić, A., Pepic, E., Smajić, E., & Kušljugić, Z. (2017) · Medical Archives · doi:10.5455/medarh.2017.71.316-319 · Cited by 23
“Given that AF is associated with significant morbidity and mortality, this increasing number of individuals with AF will have major public health implications (1-7).”
BackgroundManolis, A. S., Manolis, T. A., Manolis, A. S., & Melita, H. (2022) · Heart Failure Reviews · doi:10.1007/s10741-022-10221-1 · Cited by 21
Metadata
- Authors
- Vermond, R. A., Geelhoed, B., Verweij, N., Tieleman, R. G., Van der Harst, P., Hillege, H. L., Van Gilst, W. H., Van Gelder, I. C., & Rienstra, M.
- Affiliations
- University Medical Center Groningen (NL)
- Martini Ziekenhuis (NL)
- Corresponding author
- Rienstra, Michiel
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2015-09
- Volume
- 66
- Issue
- 9
- Pages
- 1000-1007
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W1951132801
- Cited by
- 297
- References
- 35
- Citations by year
- 2026: 17 · 2025: 27 · 2024: 38 · 2023: 37 · 2022: 29 · 2021: 24 · 2020: 23 · 2019: 22 · 2018: 21 · 2017: 25 · 2016: 31 · 2015: 3
- FWCI
- 19.37
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (publishedVersion, other-oa)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, other-oa)
- Funders
- Bayer
- Nederlandse Organisatie voor Wetenschappelijk Onderzoek (016.136.055)
- Medtronic
- Bristol-Myers Squibb
- St. Jude Medical
- Boehringer Ingelheim
- Hartstichting (NHS2010B280)
- Pfizer
- Nierstichting (E0.13)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Keywords
- atrial fibrillation, incidence, cardiovascular events, heart failure, all-cause mortality, obesity, body mass index, risk factors, antihypertensive drugs, hypertension, myocardial infarction, stroke, PREVEND study, older adults
- MeSH terms
- Adult, Aged, Atrial Fibrillation, Cause of Death, Cross-Sectional Studies, Female, Heart Failure, Humans, Male, Middle Aged, Myocardial Infarction, Netherlands, Retrospective Studies, Cohort Studies, Comorbidity, Incidence, Proportional Hazards Models, Survival Analysis, Age Distribution, Sex Distribution, Risk Assessment, Kaplan-Meier Estimate
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