Clinical study
A population-based study of the long-term risks associated with atrial fibrillation: 20-year follow-up of the Renfrew/Paisley study

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Abstract

Purpose

To describe the effect of atrial fibrillation on long-term morbidity and mortality.

Subjects and methods

The Renfrew/Paisley Study surveyed 7052 men and 8354 women aged 45–64 years between 1972 and 1976. All hospitalizations and deaths occurring during the subsequent 20 years were analyzed by the presence or absence of atrial fibrillation at baseline. Lone atrial fibrillation was defined in the absence of other cardiovascular signs or symptoms. Cox proportional hazards models were used to adjust for age and cardiovascular conditions.

Results

After 20 years, 42 (89%) of the 47 women with atrial fibrillation had a cardiovascular event (death or hospitalization), compared with 2276 (27%) of the 8307 women without this arrhythmia. Among men, 35 (66%) of 53 with atrial fibrillation had an event, compared with 3151 (45%) of 6999 without atrial fibrillation. In women, atrial fibrillation was an independent predictor of cardiovascular events (rate ratio [RR] = 3.0; 95% confidence interval [CI]: 2.1–4.2), fatal or nonfatal strokes (RR = 3.2; 95% CI: 1.0–5.0), and heart failure (RR = 3.4; 95% CI: 1.9–6.2). The rate ratios among men were 1.8 (95% CI: 1.3–2.5) for cardiovascular events, 2.5 (95% CI: 1.3–4.8) for strokes, and 3.4 (95% CI: 1.7–6.8) for heart failure. Atrial fibrillation was an independent predictor of all-cause mortality in women (RR = 2.2; 95% CI: 1.5–3.2) and men (RR = 1.5; 95% CI: 1.2–2.2). However, lone atrial fibrillation (which occurred in 15 subjects) was not associated with a statistically significant increase in either cardiovascular events (RR = 1.5; 95% CI: 0.6–3.6) or mortality (RR = 1.8; 95% CI: 0.9–3.8).

Conclusion

Atrial fibrillation is associated with an increased long-term risk of stroke, heart failure, and all-cause mortality, especially in women.

Section snippets

Sample and baseline data

Between 1972 and 1976, 7052 men and 8354 women, representing 80% of subjects aged 45–64 years residing in the towns of Renfrew and Paisley, in the west of Scotland, took part in this epidemiologic study (12). Each subject’s demographic profile and cardiorespiratory health status were documented 12, 13. Angina pectoris (classified as none, possible, or definite by the Rose angina questionnaire) and chronic bronchitis (determined by the Medical Research Council’s chronic bronchitis questionnaire)

Results

The 100 subjects with atrial fibrillation at baseline (1972–1976) were older and had more cardiovascular disease, ECG abnormalities, and a lower mean adjusted FEV1 than did subjects without atrial fibrillation (Table 1). A total of 15 subjects (10 men) had atrial fibrillation in the absence of any concurrent signs and symptoms of cardiovascular disease (“lone” atrial fibrillation). There were several significant differences between subjects with lone atrial fibrillation, the remainder of those

Discussion

A single ECG recording of atrial fibrillation in a middle-aged woman increases her risk of a cardiovascular event fivefold in the next two decades; in men, the risk is increased twofold. Much of this excess risk is related to stroke and heart failure. Atrial fibrillation is also an independent predictor of cardiovascular and all-cause mortality in both sexes. However, in the absence of concomitant cardiac disease (i.e., lone atrial fibrillation), the adverse effects of atrial fibrillation are

Acknowledgements

We gratefully acknowledge the contribution of Pauline MacKinnon, who is responsible for updating and maintaining the Renfrew/Paisley cohort database.

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    Professor Stewart is supported by the National Heart Foundation of Australia. Carole Hart is supported by grants from Chest, Heart, and Stroke Scotland and The Stroke Association, London, United Kingdom.

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