2023-10-18 07:00:17
Atrial fibrillation (AF) increases the risk of stroke, heart failure and death. In affected patients, it is recommended to prevent risk factors and, for those at increased risk of stroke, to offer oral anticoagulation.
However, it is not certain that oral anticoagulation is necessary in patients presenting with a first AF following hospitalization, as this episode may result from reversible stress.
William McIntyre of McMaster University in Hamilton (Canada) and his colleagues wanted to estimate the risk of recurrence of AF in newly diagnosed patients during hospitalization for non-cardiac surgery or a medical pathology, in comparison with a population matched with no history of AF.
A total of 139 patients hospitalized for non-cardiac surgery (707 patients) or surgical procedures (69 patients) who developed transient AF were recruited from three teaching hospitals in Hamilton. For each patient, an age- and sex-matched control participant with no history of AF was recruited from the same hospital. All patients were subsequently discharged from the hospital with normal sinus rhythm and were followed for one year.
The average age of the patients was 71 years, the average CHA2DS2-VASc score was 3 and 59% of the participants were men.
At 1 and 6 months, all patients carried out ECG monitoring, wearing a sensor for 14 days. At 1, 6 and 12 months, the patients were also seen for consultation in order to assess the evolution of their state of health, to take stock of their treatment and to note possible new episodes of AF.
The primary endpoint was atrial fibrillation lasting at least 30 seconds recorded during monitoring or noted during assessment appointments.
After one year, AF was detected in 33.1% of patients whose AF had been discovered during hospitalization, compared to 5% of the control population.
After excluding participants who had experienced electrical or pharmacological cardioversion during hospitalization and their matched controls, and limiting AF events to those detected by the sensor, a recurrence of AF was reported in 32.3% of patients with presented a first AF during hospitalization and 3% of their matched controls. Of the 46 patients who recurred, two thirds (69.6%) were diagnosed using the sensor.
After adjustment, the adjusted relative risk of recurrence was 6.6 in AF patients, compared to the control population.
These results also suggest that these recurrences can be detected through systematic clinical monitoring, note the authors.
However, they emphasize that this observational study remains relatively small, with ECG monitoring over only 28 days, and that bias may remain. The results may also not be generalizable to the entire population. New studies will therefore need to provide confirmation.
(Annals of Internal Medicine, online publication of October 2)
Source: APMnews
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