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Study: Heart failure, not stroke, most common complication of atrial fibrillation

The threat of heart failure from atrial fibrillation could be more worrisome than stroke, a new study reveals. Photo by mirkosajkov/Pixabay
1 of 2 | The threat of heart failure from atrial fibrillation could be more worrisome than stroke, a new study reveals. Photo by mirkosajkov/Pixabay

NEW YORK, April 17 (UPI) -- Doctors often tell patients with atrial fibrillation, which causes an irregular and often abnormally rapid heart rate, to beware of an increased risk of stroke. But the threat of heart failure should be even more worrisome, a new study reveals.

The study, conducted at Aalborg University in Denmark in collaboration with Tufts Medical Center and Boston Medical Center, was published Wednesday in the British Medical Journal.

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"Our nationwide study shows that the lifetime risk of atrial fibrillation increased over the past two decades from one in four to one in three," the authors wrote.

"After atrial fibrillation, heart failure was the most frequent complication, with a lifetime risk of two in five, twice greater than the lifetime risk of stroke after atrial fibrillation."

Even so, more research is needed to find new and effective preventive strategies to further decrease stroke and heart failure risks, the authors noted. They called for alignment of both randomized, clinical trials and guidelines "to better reflect the needs of the real-world population with atrial fibrillation."

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Atrial fibrillation will affect 16 million people in the United States by 2050 and 18 million people in Europe by 2060, according to the researchers, who received a grant from the Danish Cardiovascular Academy to undertake the study.

"Atrial fibrillation is a very common heart rhythm disorder," the study's lead author, Dr. Nicklas Vinter, a postdoctoral researcher in the department of clinical medicine at Aalborg University, told UPI via email.

"We wanted to understand the long-term risks better and see how these risks have changed over time," Vinter said, adding that "in many cases, living a healthy lifestyle and taking your prescribed medicine can prevent atrial fibrillation and its complications."

National data analyzed

To address a knowledge gap, researchers analyzed national data for 3.5 million Danish adults with no history of atrial fibrillation at age 45 or older to know whether they developed the condition over a 23-year period spanning 2000 to 2022.

The researchers subsequently followed all 362,721 individuals with a new diagnosis of atrial fibrillation (46% women and 54% men), but without complications, until they had a diagnosis of heart failure, stroke or heart attack.

They took into account potentially influential factors, such as history of high blood pressure, diabetes, high cholesterol, heart failure, chronic lung and kidney disease, family income and educational attainment.

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The results indicated that the lifetime risk of atrial fibrillation increased to 31% om 2011-12 from 24% in 2000-2010. The increase was greater among men and individuals with a history of heart failure, heart attack, stroke, diabetes and chronic kidney disease.

Among those with atrial fibrillation, the most common complication was heart failure (lifetime risk 41%). This was twice as large as the lifetime risk of any stroke (21%) and four times greater than the lifetime risk of heart attack (12%).

Men showed a higher lifetime risk of complications after atrial fibrillation compared with women for heart failure (44% versus 35%) and heart attack (12% versus 10%), while the lifetime risk of stroke after atrial fibrillation was slightly lower in men than women (21% vs 23%).

Over the 23-year study period, there was virtually no improvement in the lifetime risk of heart failure after atrial fibrillation (43% in 2000-10 vs 42% in 2011-22) and only slight (4% to 5%) decreases in the lifetime risks of any stroke, ischemic stroke and heart attack after atrial fibrillation, which were similar among men and women.

Among those with atrial fibrillation, 2 in 5 most likely will develop heart failure and 1 in 5 will encounter a stroke during their remaining lifetime, with little or no improvement in risk evident over the 20-year study period, the study indicated.

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Strategies needed

As a result, the researchers pointed out that strategies to prevent both heart failure and stroke are necessary for people with atrial fibrillation.

However, this was an observational study, so researchers could not draw firm conclusions about cause and effect, and they acknowledged potentially missing patients with undiagnosed atrial fibrillation.

They also lacked information about ethnicity or lifestyle factors, and the results may not apply to other countries or settings.

"This study is in line with prior published data from the U.S. that shows an increasing prevalence of atrial fibrillation," said Dr. Timothy Larsen, a cardiologist and cardiac electrophysiologist at Rush University System for Health in Chicago. He was not involved in the research.

While heart palpitations are a classic symptom of atrial fibrillation, patients also should pay attention to more subtle or generalized symptoms, such as fatigue and shortness of breath, which usually occurs with exertion. Controlling atrial fibrillation can improve these symptoms, Larsen said.

Many patients have been able to prevent stroke and death --"the most devastating consequences" of atrial fibrillation -- by taking very safe and effective drugs, such as blood thinners, said Dr. Gregory Marcus, a cardiologist and endowed professor of atrial fibrillation research at the University of California-San Francisco.

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As a result, "it's important to emphasize that heart failure and not stroke is the most common complication of atrial fibrillation specifically in this modern era," Marcus said.

Strong evidence demonstrates that "eradication of atrial fibrillation with catheter ablation procedures can substantially improve heart failure and even significantly prolong longevity," he added.

Despite the new emphasis on heart failure as a complication of atrial fibrillation, the risk of stroke can't be understated, said Dr. Paul Johnson, medical director of the Comprehensive Stroke Center at Intermountain Medical Center in Murray, Utah.

As a neurohospitalist and vascular neurologist, Johnson said he recommends that patients remember the acronym BEFAST, as suggested by many health systems, to remain alert for signs of a stroke.

The first five letters stand for sudden changes in balance, eyes, face, arms and speech, while the "T" represents time because calling 911 immediately is critical to prevent brain damage.

Both the American Stroke Association and the Centers for Disease Control and Prevention abbreviate the acronym to FAST because acting fast is key to stroke survival.

"This study draws attention to the high prevalence of atrial fibrillation in the general population, and in fact, suggests that the prevalence of this condition is increasing," Johnson said.

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"Because atrial fibrillation is associated with several significant medical complications, including stroke and heart failure, this represents a serious public health issue."

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