Cited by 297Atrial Fibrillation Management and OutcomesCardiac electrophysiology and arrhythmiasCardiac Health and Mental Health

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Incidence of Atrial Fibrillation and Relationship With Cardiovascular Events, Heart Failure, and Mortality

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Vermond, Rob A., Geelhoed, Bastiaan, Verweij, Niek, Tieleman, Robert G., Van der Harst, Pim, Hillege, Hans L., Van Gilst, Wiek H., Van Gelder, Isabelle C., Rienstra, Michiel·2015·Journal of the American College of Cardiology

DOI 10.1016/j.jacc.2015.06.1314

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Abstract

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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Background
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BackgroundInfluential
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“HF: Heart failure AF: Atrial fibrillation LVDD: Left ventricular dysfunction HFpEF: Heart failure with preserved ejection fraction LVDF: Left ventricular diastolic function EDV: End-diastolic volume ABP: Invasive arterial blood pressure SR: Sinus rhythm RRI: RR intervals PP: Pulse pressure SM: Simple model EM: Expande…”
BackgroundInfluential
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Observing the Obvious∗
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“(3) and are not commonly reported in the literature.”
BackgroundInfluential
Letter: Conflicting and unresolved issue of the prognostic value of atrial fibrillation for chronic heart failure patients — Response
Kotecha, D. (2016) · International Journal of Cardiology · doi:10.1016/j.ijcard.2016.03.107
“already been made clear from numerous published reports (3-8).”
Reply
Vermond, R. A., Geelhoed, B., & Rienstra, M. (2016) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2016.01.048
Risk factors for atrial fibrillation incidence and progression
Vermond, R. A. (2016) · University of Groningen research database (University of Groningen / Centre for Information Technology)
INDICATORS OF STRUCTURAL AND FUNCTIONAL CHANGES IN THE MYOCARDIUM AS PREDICTORS OF THE ATRIAL FIBRILLATION IN PATIENTS WITH HEART FAILURE AND PRESERVED EJECTION FRACTION
Черняєва, К. І., Rudenko, Y., Mostbauer, G., Bezrodnyi, A., Shevchuk, M., Саблін, А. В., Moskalenko, Y., & Ковтун, Е. Г. (2019) · Ukrainian Scientific Medical Youth Journal · doi:10.32345/usmyj.4(112).2019.32-46
The Research Progress of Cardiac Implantable Electronic Device-Identified Atrial Fibrillation
卢, 江. (2020) · Advances in Clinical Medicine · doi:10.12677/acm.2020.103036
Épidémiologie et mécanismes de la fibrillation atriale
Lacroix, D., & Klein, C. (2020) · Bulletin de l Académie Nationale de Médecine · doi:10.1016/j.banm.2020.07.049 · Cited by 1
ATRIAL FIBRILLATION AND ADHERENCE TO ORAL ANTICOAGULATION: REVIEW OF CLINICAL CASES
Dzeshka, M. S., Бойко, С. Л., Шпак, Н. В., & Snezhitskiy, V. А. (2020) · Emergency Cardiology and Cardiovascular Risks · doi:10.51922/2616-633x.2020.4.2.1019
Previous Catheter Ablation Predicts In-Hospital Restoration of Sinus Rhythm in Patients Presenting with Recent-Onset Atrial Fibrillation—The Retrospective HAMBURG-AF Study
Steinberg, B. S., Aydin, M. A., Moser, A., Ojeda, F., & Karakas, M. (2021) · Medicina · doi:10.3390/medicina57080776
“Affected patients have an increased risk for thromboembolic events and the development of heart failure, and catheter ablation has now emerged as key interventional therapy and is recommended for drug-refractory AF, although recurrences of AF are common [5].”
Background
Dilemas de la insuficiencia cardíaca con fracción de eyección preservada
(2021) · Revista Uruguaya de Cardiología · doi:10.29277/cardio.37.1.17
Ultrasound Examinations
大門, 雅. (2023) · JAPANES JOURNAL OF MEDICAL INSTRUMENTATION · doi:10.4286/jjmi.93.102
Association of Oxidative Stress-related Biomarkers and Atrial Fibrillation: A Cross- Sectional StudyPreprint
Wang, X., Zhang, Y., Ren, M., Guo, J., Li, Z., Zheng, S., Wang, X., Du, J., Gao, M., & Hou, Y. (2023) · Research Square · doi:10.21203/rs.3.rs-3063179/v1
Bidirectional association and shared risk factors between atrial fibrillation and heart failure: a Mendelian Randomization studyPreprint
Lu, H., Gao, Z., Wei, H., Wei, Y., Qiu, Z., Xiao, J., & Huang, W. (2023) · medRxiv · doi:10.1101/2023.08.21.23294384
Atrial Fibrillation and Hypertension: Complications and Comorbidities
Čusto, E. B., Ćemalović, S., Bajrić, S., & Cemalovic, N. (2023) · Cardiologia Croatica · doi:10.15836/ccar2024.65
Impact of Atrial Fibrillation on Heart Failure with Preserved Ejection Fraction: An Observational Cross-sectional Study from Western India
Shastri, M. H., Vinod, V., Mistry, H. P., Rathod, V. M., Gohil, N. V., Dobariya, R. K., & Patel, N. S. (2023) · APIK Journal of Internal Medicine · doi:10.4103/ajim.ajim_50_23
Radiofrequency ablation using the ThermoCool SmartTouch Catheter guided by ablation index versus antiarrhythmic drugs in atrial fibrillation treatment in China: a cost-consequence analysis.
Zhang, B., Han, J., Zhou, D., Jiang, J., Zhong, J., Lu, Y., Zuo, C., Lu, X., Xuan, J., Zu, A., et al. (2024) · PubMed Central · doi:10.57264/cer-2023-0035
Catheter ablation as a potential treatment alternative for atrial fibrillation among patients with heart failure with preserved ejection fraction: a retrospective cohort studyPreprint
Ping, Y., Guoqiang, W., Tiantian, A., Mingbao, S., Yu, X.-J., & Xiaoying, L. (2024) · Research Square · doi:10.21203/rs.3.rs-3935654/v1
Long-Term Clinical Outcomes Following Cryoballoon Ablation in Patients with Paroxysmal Atrial Fibrillation: Single-Center Experience
Can, C. (2024) · Comprehensive Medicine · doi:10.14744/cm.2024.62207
“[5] The treatment of AF consists of three main components: rate control, rhythm control, and anticoagulation.”
Background
RE: Clinical implication of detected tachyarrhythmias in patients with implantable cardioverter defibrillators
Ojo, A. O., & Goldenberg, I. (2024) · Journal of Cardiovascular Electrophysiology · doi:10.1111/jce.16306
Atrial Fibrillation in Heart Failure: Strategies for Restoring Sinus Rhythm
Atreya, A. R., Arora, S., Subramanian, M., Yalagudri, S. D., Narasimhan, C., & Saggu, D. K. (2024) · Indian Journal of Clinical Cardiology · doi:10.1177/26324636241261456
Hospitalizations of Patients with Atrial Fibrillation (AF) in Poland: A Nationwide Study Based on over One Million AF Hospitalizations in 2017–2021
Dąbrowska, M., Rząd, M., Kanecki, K., Lewtak, K., Tyszko, P. Z., Goryński, P., & Nitsch-Osuch, A. S. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13216592
“Increasing age is the most important risk factor for atrial fibrillation [3].”
BackgroundInfluential
The optimized efficiency of pulmonary vein isolation shortened the procedure time but did not improve the success rate in paroxysmal atrial fibrillationPreprint
Zhang, L., Xie, Y., Hu, X., Ma, D., & Huang, Y. (2024) · Research Square · doi:10.21203/rs.3.rs-5360355/v1
Investigation of the frequency of causes of atrial fibrillation in hospitalized patients diagnosed with AF in the heart department of Taleghani Hospital in Urmia
Mohammadi, R., Rostamzadeh, A., Khademvatani, K., & Yekta, Z. (2024) · Health Science Monitor · doi:10.61186/hsm.3.4.348
Age‐Specific Association Between Cumulative Blood Pressure Exposure and Atrial Fibrillation Risk in Adults
Yan, Y., Liu, Q., Wang, Z., Wang, H., & Chang, P. (2025) · Journal of the American Heart Association · doi:10.1161/jaha.125.040958
Mortality Trends in Atrial Fibrillation and Renal Failure Among Older US Adults: A 25-Year Retrospective Analysis (1999–2024)
Hasan, M., Chola, M. H., Ali, T., Azeem, B., Chola, M. S., Naveed, M. A., Ali, A., Soni, K., Jain, H., Chigurupati, H. D., et al. (2025) · Cardiology in Review · doi:10.1097/crd.0000000000001058
Utility of biological aging acceleration in capturing transitions of atrial fibrillation and dementia: a population-based study
Liu, Y., & Li, C. (2025) · npj Aging · doi:10.1038/s41514-025-00274-5
Multimorbidity and risk of atrial fibrillation in the Lifelines cohort
van Deutekom, C., Weil, L. I., Middeldorp, M. E., Samuel, M., Geelhoed, B., Velt, M. J. H., Zwartkruis, V. W., Hanssen, D. J. C., Munster, B. C. V., Voshaar, R. C. O., et al. (2025) · European Heart Journal Open · doi:10.1093/ehjopen/oeaf164
“9,30 Few other studies investigated the association between clusters and the risk of incident AF using latent class analysis.”
Additional file 1 of The association of cardiac troponin and cardiovascular events in patients with concomitant heart failure preserved ejection fraction and atrial fibrillation
Kim, B. S., Kwon, C. H., Chang, H., Choi, J.-H., Kim, H.-J., & Kim, S. H. (2023) · Figshare · doi:10.6084/m9.figshare.23167645
Additional file 1 of Cost-utility analysis of TAVI compared with surgery in patients with severe aortic stenosis at low risk of surgical mortality in the Netherlands
Eerdekens, R., Kats, S., Grutters, J. P. C., Green, M., Shore, J., Candolfi, P., Oortwijn, W., van der Harst, P., & Tonino, P. A. L. (2024) · Figshare · doi:10.6084/m9.figshare.25478838
Harnessing Machine Learning for Predicting Atrial Fibrillation from Electrocardiogram Signals
Parale, G. P., Parale, H., Parale, C., & Kumar, S. (2025) · Journal of the Practice of Cardiovascular Sciences · doi:10.4103/jpcs.jpcs_35_25
Effects of catheter ablation on the clinical outcomes of young patients aged ≤35 years with atrial fibrillation: A retrospective study
Chen, J., Chen, S.-F., Li, M., Zhang, L.-M., Li, X., Yan, L.-J., Hu, J., Sun, F., Hu, G.-L., Huang, L.-L., et al. (2026) · Medicine · doi:10.1097/md.0000000000047183
“[12] However, the effects of catheter ablation on the prognosis of young patients aged ≤35 years with AF are not well understood.”
Procedural Parameters in Predicting Late Recurrence Following Catheter Ablation of Paroxysmal Atrial Fibrillation
Xie, Y. F., Hu, X., Ma, D., Zhang, L., & Huang, Y. (2026) · Journal of Clinical Medicine · doi:10.3390/jcm15062409
“Catheter-based point-by-point radiofrequency ablation (RFA) is the most widely used technique and has proven to have a high success of AF-free rate [3,4].”
Differential HFpEF Response After Catheter Ablation in Persistent AF Patients With Small Low Voltage Areas
Egami, Y., Mukai, T., Kise, M., Kobayashi, N., Sugino, A., Abe, M., Nohara, H., Kawanami, S., Yasumoto, K., Okamoto, N., et al. (2026) · Pacing and Clinical Electrophysiology · doi:10.1111/pace.70300
Closing the quality gap: analysis of implementation barriers and interventions for postoperative exercise rehabilitation for patients with radiofrequency ablation for atrial fibrillation
Lu, B., Sun, Y., He, L., Sun, S., Wu, J., Chen, B., Fan, H., & Zhao, Z. (2026) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2026.1757839
Exercise for Atrial Fibrillation: Unmasking Comorbidities and Improving Treatment
Dziano, J. K., Ariyaratnam, J., Middeldorp, M. E., Sanders, P., & Elliott, A. D. (2026) · Exercise and Sport Sciences Reviews · doi:10.1249/jes.0000000000000391
Bruton tyrosine kinase inhibitors and cardiovascular adverse events
Camilli, M., Madaudo, C., Salvatorelli, E., Minotti, G., & Menna, P. (2026) · British Journal of Pharmacology · doi:10.1111/bph.70620
Mineralocorticoid receptor overactivation in heart failure with preserved ejection fraction
Kobayashi, M., Pitt, B., & Zannad, F. M. (2026) · European Heart Journal · doi:10.1093/eurheartj/ehag578
Association of HFA-PEFF Score with Left Atrial Mechanics, Pressure, and Reverse Remodeling in Atrial Fibrillation
Konoma, S., Nakanishi, K., Daimon, M., Hirose, K., Iwama, K., Mukai, Y., Yamamoto, Y., Kobayashi, S., Seki, H., Yoshida, Y., et al. (2026) · Journal of the American Society of Echocardiography · doi:10.1016/j.echo.2026.08.013
The Role of the Pace-And-Ablate Strategy in the Modern Management of Refractory Atrial Fibrillation
Gupta, A. R., DeSimone, C. V., & Siontis, K. C. (2026) · Current Cardiovascular Risk Reports · doi:10.1007/s12170-026-00791-2
“The elevated risk of HF in patients with AF is true for both HFrEF and HFpEF, respectively [ 96 ].”
High‐Density Spectral Analysis for Bi‐Atrial Arrhythmogenic Substrate During Non‐Paroxysmal Atrial Fibrillation
Tomura, N., Senoo, K., Okawa, T., Kakei, Y., Kawai, K., Makino, M., Munakata, J., Miki, T., Kato, Y., Fukui, K., et al. (2026) · Journal of Arrhythmia · doi:10.1002/joa3.70477
Catheter ablation for atrial fibrillation in very young adults: Multicentric data from the AF-YOUNG registry
Doldi, F., Pavel, F., Kreimer, F., Wolfes, J., Ackmann, J., Frommeyer, G., Lüker, J., Güner, F., Köbe, J., Steven, D., et al. (2026) · Heart Rhythm · doi:10.1016/j.hrthm.2026.09.028

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
ORCID: Verweij, Niek
Tieleman, Robert G.
Hillege, Hans L.
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)
DOI: 10.1016/j.jacc.2015.06.1314
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: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/open-access/userlicense/1.0/ (vor, 366 d)
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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Incidence of Atrial Fibrillation and Relationship With Cardiovascular Events, Heart Failure, and Mortality

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