Abstract
Aims It is unknown whether screen-detected atrial fibrillation (AF) carries cardiovascular risks similar to clinically detected AF. We aimed to compare clinical outcomes between individuals with screen-detected and clinically detected incident AF. Methods We studied 8265 participants (age 49 ± 13 years, 50% women) without prevalent AF from the community-based Prevention of Renal and Vascular End-stage Disease (PREVEND) study. By design of the PREVEND study, 70% of participants had a urinary albumin concentration >10 mg/L. Participants underwent 12-lead ECG screening at baseline and every 3 years. AF was considered screen-detected when first diagnosed during a study visit and clinically detected when first diagnosed during a hospital visit. We analysed data from the baseline visit (1997-1998) up to the third follow-up visit (2008). We used Cox regression with screen-detected and clinically detected AF as time-varying covariates to study the association of screen-detected and clinically detected AF with all-cause mortality, incident heart failure (HF) and vascular events. Results During a follow-up of 9.8 ± 2.3 years, 265 participants (3.2%) developed incident AF, of whom 60 (23%) had screen-detected AF. The majority of baseline characteristics were comparable between individuals with screen-detected and clinically detected AF. Unadjusted, both screen-detected and clinically detected AF were strongly associated with mortality, incident HF, and vascular events. After multivariable adjustment, screen-detected and clinically detected AF remained significantly associated with mortality (HR 2.21 (95% CI 1.09 to 4.47) vs 2.95 (2.18 to 4.00), p for difference=0.447) and incident HF (4.90 (2.28 to 10.57) vs 3.98 (2.49 to 6.34), p for difference=0.635). After adjustment, screen-detected AF was not significantly associated with vascular events, whereas clinically detected AF was (1.12 (0.46 to 2.71) vs 1.92 (1.21 to 3.06), p for difference=0.283). Conclusion Screen-detected incident AF was associated with an increased risk of adverse outcomes, especially all-cause mortality and incident HF. The risk of outcomes was not significantly different between screen-detected AF and clinically detected AF.
| Original language | English |
|---|---|
| Article number | e001786 |
| Journal | Open Heart |
| Volume | 8 |
| Issue number | 2 |
| DOIs | |
| Publication status | Published - 30 Dec 2021 |
| Externally published | Yes |
Bibliographical note
Funding Information:Funding This work was supported by the Dutch Heart Foundation [CVON RED-CVD, grant 2017–11]. The PREVEND study was supported by the Dutch Kidney Foundation [grant E0.13].
Funding Information:
Competing interests For the current manuscript, the authors declare no potential conflicts of interest. Outside of the submitted work, the authors disclosed the following financial support: RAdB. reports grants from the Dutch Heart Foundation (CVON SHE-PREDICTS-HF, grant 2017-21; CVON RED-CVD, grant 2017-11; CVON PREDICT2, grant 2018-30; and CVON DOUBLE DOSE, grant 2020B005), leDucq Foundation (Cure PhosphoLambaN induced Cardiomyopathy (Cure-PLaN)), and the European Research Council (SECRETE-HF, ERC CoG 818715). The UMCG, which employs RAdB., has received research grants and/or fees from AstraZeneca, Abbott, Boehringer Ingelheim, Cardior Pharmaceuticals Gmbh, Ionis Pharmaceuticals, Inc., Novo Nordisk, and Roche. RAdB. has received speaker fees from Abbott, AstraZeneca, Bayer, Novartis, and Roche. MR reports grants from the Dutch Heart Foundation (CVON RACE V, grant 2014-09; CVON RED-CVD, grant 2017-11; CVON-AI, grant 2018B017; DECISION, grant 2018B024). The UMCG, which employs MR, has received grants from SJM/Abbott (VIP-HF study) and Medtronic (Cryoballoon AF registry/biobank study).
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