University of Besançon, France (J.-P.B.).
Thrombosis Research Institute, London, UK (J.-P.B., S.V., G.K., K.S.P., A.K.K.).
Circulation. 2019 Feb 5;139(6):787-798. doi: 10.1161/CIRCULATIONAHA.118.035012.
Atrial fibrillation is associated with increased risks of death, stroke/systemic embolism, and bleeding (incurred by antithrombotic therapy), which may occur early after diagnosis.
We assessed the risk of early events (death, stroke/systemic embolism, and major bleeding) over 12 months and their relation to the time after diagnosis of atrial fibrillation in 52 014 patients prospectively enrolled in the GARFIELD-AF registry (Global Anticoagulant Registry in the FIELD-Atrial Fibrillation) between March 2010 and August 2016.
Over 12 months, 2140 patients died (mortality rate, 4.3; 95% CI, 4.2-4.5 per 100 person-years), of whom 288 (13.5%) died in the first month (6.8; 95% CI, 6.1-7.6). Over 12 months, 657 patients had a stroke/systemic embolism (1.3; 95% CI, 1.2-1.4) and 411 had a major bleeding (0.8; 95% CI, 0.8-0.9). During the first month, the rates (per 100 person-years) of stroke/systemic embolism and major bleed were 2.3 (95% CI, 1.9-2.8) and 1.5 (95% CI, 1.2-1.9), respectively. The elevated 1-month mortality rate was mostly attributable to cardiovascular mortality (3.5; 95% CI, 3.0-4.1), in particular, heart failure, sudden death, and acute coronary syndromes (1.0 [95% CI, 0.8-1.4], 0.6 [95% CI, 0.4-0.8], and 0.5 [95% CI, 0.3-0.8], respectively). Age, heart failure, prior stroke, history of cirrhosis, vascular disease, moderate-to-severe kidney disease, diabetes mellitus, and living in North or Latin America were independent predictors of a higher risk of early death, whereas anticoagulation and living in Europe or Asia were independent predictors of a lower risk of early death. A predictive model developed for the 1-month risk of death had a C-statistic of 0.81 (95% CI, 0.78-0.83).
The increased hazard of early events, in particular, cardiovascular mortality, in newly diagnosed atrial fibrillation points to the importance of comprehensive care for such patients and should alert clinicians to detect warning signs of possible early mortality.
URL: https://www.clinicaltrials.gov . Unique identifier: NCT01090362.
房颤与死亡、卒中/全身性栓塞和出血（抗栓治疗所致）风险增加相关，这些风险可能在诊断后早期发生。
我们评估了 52014 例前瞻性入组的 GARFIELD-AF 登记研究（FIELD-房颤全球抗凝注册研究）患者在诊断后 12 个月内早期事件（死亡、卒中/全身性栓塞和大出血）的风险及其与时间的关系。该研究于 2010 年 3 月至 2016 年 8 月间进行。
在 12 个月期间，2140 例患者死亡（死亡率为 4.3；95%CI，4.2-4.5/100 人年），其中 288 例（13.5%）在第 1 个月死亡（6.8；95%CI，6.1-7.6）。在 12 个月期间，657 例患者发生卒中/全身性栓塞（1.3；95%CI，1.2-1.4），411 例发生大出血（0.8；95%CI，0.8-0.9）。在第 1 个月，卒中/全身性栓塞和大出血的发生率（/100 人年）分别为 2.3（95%CI，1.9-2.8）和 1.5（95%CI，1.2-1.9）。1 个月时升高的死亡率主要归因于心血管死亡率（3.5；95%CI，3.0-4.1），特别是心力衰竭、猝死和急性冠脉综合征（1.0[95%CI，0.8-1.4]、0.6[95%CI，0.4-0.8]和 0.5[95%CI，0.3-0.8]）。年龄、心力衰竭、既往卒中、肝硬化病史、血管疾病、中重度肾脏疾病、糖尿病和居住在北美或拉丁美洲是早期死亡风险较高的独立预测因素，而抗凝治疗和居住在欧洲或亚洲是早期死亡风险较低的独立预测因素。为 1 个月死亡风险开发的预测模型的 C 统计量为 0.81（95%CI，0.78-0.83）。
新发房颤患者早期事件（尤其是心血管死亡）风险增加，提示此类患者需要全面护理，应引起临床医生注意，及时发现可能发生早期死亡的警告信号。
