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CLINICAL RESEARCH: HEART RHYTHM DISORDER

Mortality Trends in Patients Diagnosed With First Atrial Fibrillation

A 21-Year Community-Based Study

Yoko Miyasaka, MD, PhD, FACC^_*, Marion E. Barnes, MSc^_*, Kent R. Bailey, PhD, Stephen S. Cha, MS, Bernard J. Gersh, MB, ChB, DPhil, FACC^_*, James B. Seward, MD, FACC^_* and Teresa S.M. Tsang, MD, FACC^_*,_*

^_* Division of Cardiovascular Disease and Internal Medicine, Mayo Clinic, Rochester, Minnesota.
Section of Biostatistics, Mayo Clinic, Rochester, Minnesota.

Manuscript received March 27, 2006; revised manuscript received October 19, 2006, accepted October 23, 2006.

^_* Reprint requests and correspondence: Dr. Teresa S. M. Tsang, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905. (Email: tsang.teresa{at}mayo.edu).

Objectives: The purpose of this study was to assess the mortality trends of atrial fibrillation (AF) in a community.

Background: Limited data exist regarding the mortality trends of patients diagnosed with first AF.

Methods: A community-based cohort of adult residents of Olmsted County, Minnesota, who had electrocardiogram-confirmed first-documented AF in the years 1980 to 2000 were identified and followed to 2004 or death. The primary outcome was all-cause mortality.

Results: Of a total of 4,618 residents (mean age 73 ± 14 years) diagnosed with first AF, 3,085 died during a mean follow-up of 5.3 ± 5.0 years. Relative to the age- and gender-matched general Minnesota population, the mortality risk was increased (p < 0.0001) with a hazard ratio (HR) of 9.62 (95% confidence interval [CI] 8.93 to 10.32) within the first 4 months and 1.66 (95% CI 1.59 to 1.73) thereafter. Cox proportional hazards modeling showed no change in overall age- and gender-adjusted mortality (HR for the year 2000 vs. 1980: 0.99; 95% CI 0.86 to 1.13; p = 0.84), even after adjustment for comorbidities. In secondary analyses, no changes in mortality were seen for early (within first 4 months) or late (after 4 months) mortality for the entire group or within the subgroup of patients who did not have cardiovascular disease at baseline.

Conclusions: In this cohort of patients newly diagnosed with AF, mortality risk was high, especially within the first 4 months. There was no evidence for any significant changes over the 21 years in terms of overall mortality, early or late mortality, or mortality among patients without pre-existing cardiovascular disease.

Abbreviations and Acronyms   AF = atrial fibrillation   CI = confidence interval   HR = hazard ratio

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