Impact of Awareness and Patterns of Nonhospitalized Atrial Fibrillation on the Risk of Mortality: The Reasons for Geographic And Racial Differences in Stroke (REGARDS) Study.

Academic Article

Abstract

  • BACKGROUND: Although mortality associated with atrial fibrillation (AF) has been reported to decrease over prior decades, the mortality risk of asymptomatic, nonhospitalized AF has not been examined. HYPOTHESIS: Asymptomatic, nonhospitalized AF is associated with an increased risk of death. METHODS: This analysis included 25,976 participants (mean age, 65 ± 9.4 years; 55% female; 38% black) from the Reasons for Geographic And Racial Differences (REGARDS) study. Atrial fibrillation was detected on the baseline electrocardiogram (ECG AF) or by self-reported history. Atrial fibrillation unawareness was defined as present if ECG evidence of the arrhythmia was detected but no self-reported history was reported. All-cause mortality was confirmed during follow-up through March 31, 2014. RESULTS: A total of 2208 (8.5%) participants had AF at baseline (ECG: n = 371/17%; self-reported: n = 1837/83%). Over a median follow-up of 7.6 years, 3481 deaths occurred. In a multivariable Cox regression model, AF was associated with a 32% increased risk of mortality (95% confidence interval [CI]: 1.19-1.46). Risk of death was higher among those with ECG AF (hazard ratio: 1.71, 95% CI: 1.42-2.07) compared with self-reported cases (hazard ratio: 1.15, 95% CI: 1.03-1.29). Those who were unaware of their AF diagnosis had a 94% increased risk of death (95% CI: 1.50-2.52) compared with AF participants who were aware of their diagnosis. CONCLUSIONS: Asymptomatic, nonhospitalized AF is associated with an increased risk of mortality in the general population. Mortality is higher in those with ECG-confirmed cases and among those who are unaware of their diagnosis.
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    Keywords

  • Aged, Asymptomatic Diseases, Atrial Fibrillation, Awareness, Cause of Death, Chi-Square Distribution, Electrocardiography, Female, Health Knowledge, Attitudes, Practice, Health Status Disparities, Humans, Incidence, Kaplan-Meier Estimate, Male, Middle Aged, Multivariate Analysis, Proportional Hazards Models, Risk Assessment, Risk Factors, Stroke, Time Factors, United States
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    Author List

  • O'Neal WT; Efird JT; Judd SE; McClure LA; Howard VJ; Howard G; Soliman EZ
  • Start Page

  • 103
  • End Page

  • 110
  • Volume

  • 39
  • Issue

  • 2