Inflammation and risk of cardiovascular outcomes in patients with atrial fibrillation and flutter: A nationwide registry study.

BACKGROUND

Atrial fibrillation (AF) is associated with the development of heart failure (HF). Inflammation is increasingly recognized as a driver for cardiovascular disease, but the impact of inflammation on the risk of cardiovascular outcomes in AF requires further investigation.

OBJECTIVE

This study aimed to establish the prognostic value of C-reactive protein (CRP) in relation to CV outcomes in patients with AF treated with first-time direct current cardioversion.

METHODS

A nationwide study of 8691 first-time direct current cardioverted patients with AF from 2011 to 2018 was conducted using the Danish National Health Registries for baseline comorbidities and prescribed medications. New-onset cardiovascular diagnoses were the primary outcomes, registered either at the outpatient clinic or upon admission. Incidence rates were reported, and multivariable adjusted Cox proportional hazard models presented the hazard ratios (HRs) for outcomes.

RESULTS

During a median follow-up time of 719 days (interquartile range 328-1168 days), 568 (8.2%) developed HF. Higher CRP was associated with an increased risk of incident HF in univariable analysis (HR 1.07 per 1 mg/L increase in CRP, 95% confidence interval [CI] 1.05-1.08, P < .001) and multivariable analysis (HR 1.06, 95% CI 1.04-1.08, P < .001). Likewise, patients with CRP of > 3 mg/L had an increased risk of incident HF (HR 1.78, 95% CI 1.51-2.10, P < .001) compared with patients with CRP of ≤ 3 mg/L.

CONCLUSION

In patients with AF, increased CRP was associated with an increased long-term risk of HF, ischemic heart disease, and CV death, even after multivariable adjustments. These results suggest that CRP may be a valuable risk marker in patients with AF.