TY - JOUR
T1 - Atrial fibrillation in patients with cardiomyopathy
T2 - Prevalence and clinical outcomes from real-world data
AU - Buckley, Benjamin J.R.
AU - Harrison, Stephanie L.
AU - Gupta, Dhiraj
AU - Fazio-Eynullayeva, Elnara
AU - Underhill, Paula
AU - Lip, Gregory Y.H.
N1 - Funding Information:
Dr Buckley has received funding from Bristol-Myers Squibb/Pfizer. Dr Harrison has received funding from Bristol-Myers Squibb. E. Fazio-Eynullayeva and P. Underhill are employees of TriNetX Inc. Dr Gupta has received institutional research grants from Boston Scientific, Medtronic, and Biosense Webster, and personal advisory fees from Boehringer Ingelheim, Boston Scientific and Abbott. Dr Lip is a consultant for Bayer/ Janssen, Bristol-Myers Squibb/Pfizer, Medtronic, Boehringer Ingelheim, Novartis, Verseon, and Daiichi-Sankyo, and speaker for Bayer, Bristol-Myers Squibb/ Pfizer, Medtronic, Boehringer Ingelheim, and Daiichi-Sankyo. No fees are directly received personally. The remaining authors have no disclosures to report.
Publisher Copyright:
© 2021 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
PY - 2021/12/7
Y1 - 2021/12/7
N2 - BACKGROUND: Cardiomyopathy is a common cause of atrial fibrillation (AF) and may also present as a complication of AF. However, there is a scarcity of evidence of clinical outcomes for people with cardiomyopathy and concomittant AF. The aim of the present study was therefore to characterize the prevalence of AF in major subtypes of cardiomyopathy and investigate the impact on important clinical outcomes. METHODS AND RESULTS: A retrospective cohort study was conducted using electronic medical records from a global federated health research network, with data primarily from the United States. The TriNetX network was searched on January 17, 2021, including records from 2002 to 2020, which included at least 1 year of follow-up data. Patients were included based on a diagnosis of hypertrophic, dilated, or restrictive cardiomyopathy and concomitant AF. Patients with cardiomyopathy and AF were propensity-score matched for age, sex, race, and comorbidities with patients who had a cardiomyopathy only. The outcomes were 1-year mortality, hospitalization, incident heart failure, and incident stroke. Of 634 885 patients with cardiomyopathy, there were 14 675 (2.3%) patients with hypertrophic, 90 117 (7.0%) with restrictive, and 37 685 (5.9%) with dilated cardiomyopathy with concomitant AF. AF was associated with significantly higher odds of all-cause mortality (odds ratio [95% CI]) for patients with hypertrophic (1.26 [1.13–1.40]) and dilated (1.36 [1.27–1.46]), but not restrictive (0.98 [0.94–1.02]), cardiomyopathy. Odds of hospitalization, incident heart failure, and incident stroke were significantly higher in all cardiomyopathy subtypes with concomitant AF. Among patients with AF, catheter ablation was associated with significantly lower odds of all-cause mortality at 12 months across all cardiomyopathy subtypes. CONCLUSIONS: Findings of the present study suggest AF may be highly prevalent in patients with cardiomyopathy and associated with worsened prognosis. Subsequent research is needed to determine the usefulness of screening and multisdisciplinary treatment of AF in this population.
AB - BACKGROUND: Cardiomyopathy is a common cause of atrial fibrillation (AF) and may also present as a complication of AF. However, there is a scarcity of evidence of clinical outcomes for people with cardiomyopathy and concomittant AF. The aim of the present study was therefore to characterize the prevalence of AF in major subtypes of cardiomyopathy and investigate the impact on important clinical outcomes. METHODS AND RESULTS: A retrospective cohort study was conducted using electronic medical records from a global federated health research network, with data primarily from the United States. The TriNetX network was searched on January 17, 2021, including records from 2002 to 2020, which included at least 1 year of follow-up data. Patients were included based on a diagnosis of hypertrophic, dilated, or restrictive cardiomyopathy and concomitant AF. Patients with cardiomyopathy and AF were propensity-score matched for age, sex, race, and comorbidities with patients who had a cardiomyopathy only. The outcomes were 1-year mortality, hospitalization, incident heart failure, and incident stroke. Of 634 885 patients with cardiomyopathy, there were 14 675 (2.3%) patients with hypertrophic, 90 117 (7.0%) with restrictive, and 37 685 (5.9%) with dilated cardiomyopathy with concomitant AF. AF was associated with significantly higher odds of all-cause mortality (odds ratio [95% CI]) for patients with hypertrophic (1.26 [1.13–1.40]) and dilated (1.36 [1.27–1.46]), but not restrictive (0.98 [0.94–1.02]), cardiomyopathy. Odds of hospitalization, incident heart failure, and incident stroke were significantly higher in all cardiomyopathy subtypes with concomitant AF. Among patients with AF, catheter ablation was associated with significantly lower odds of all-cause mortality at 12 months across all cardiomyopathy subtypes. CONCLUSIONS: Findings of the present study suggest AF may be highly prevalent in patients with cardiomyopathy and associated with worsened prognosis. Subsequent research is needed to determine the usefulness of screening and multisdisciplinary treatment of AF in this population.
KW - Atrial fibrillation
KW - Cardiomyopathy
KW - Comorbidity
KW - MACE
KW - Preventive cardiology
KW - Secondary prevention
UR - http://www.scopus.com/inward/record.url?scp=85120959641&partnerID=8YFLogxK
U2 - 10.1161/JAHA.121.021970
DO - 10.1161/JAHA.121.021970
M3 - Article
C2 - 34779218
AN - SCOPUS:85120959641
SN - 2047-9980
VL - 10
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 23
M1 - e021970
ER -