Atrial fibrillation and its accompanying risks on the rise in Asian patients

First large-scale investigation of AF in Taiwan shows increasing risks, according to a new study in the journal CHEST®

February 5, 2018

Glenview, IL – Atrial fibrillation (AF) is the most prevalent sustained cardiac arrhythmia, and its prevalence is projected to rise continuously over the next few decades because of an aging population. However, studies of time trends on the incidence, prevalence, and lifetime risks of AF among Asians are limited. In a new study published in the journal CHEST®, researchers report on the first large-scale study of almost 300,000 patients in Taiwan with new-onset AF.

“The burden of AF among Asian patients is increasing, with a lifetime risk of AF being appropriately 1 in 7,” explained lead investigator Ming-Hsiung Hsieh, MD, Division of Cardiovascular Medicine, Taipei Wan-Fang Hospital, Taipei, Taiwan. This results in significant mortality, heart failure, ischemic stroke, dementia, sudden cardiac death, and myocardial infarction. Optimized management of any associated medical conditions should be part of the holistic management approach for AF.”

Using records from the National Health Insurance Research Database (NHIRD), which covers more than 99 percent of Taiwanese citizens, researchers identified 289,559 newly confirmed cases of AF between January 1, 1996, and December 31, 2011.

This study observed that the incidence of AF in 2011 in Taiwan among the Chinese population was 1.51 per 1,000 person-years in 2011, with a lifetime risk of AF being appropriately 1 in 6 for men and 1 in 7 for women over 20 years of age. The prevalence of AF was 1.07 percent in Taiwan in 2011 and is estimated that it will rise to 4.01 percent in 2050. Compared with patients without AF, AF was associated with an increased risk of mortality, heart failure, ischemic stroke, dementia, sudden cardiac death, and myocardial infarction. These findings are different from data from studies of primarily Caucasians, such as the Framingham study, which cites a 1 in 4 risk for men and women 40 years and older, and the Rotterdam study, which indicates the lifetime risk of developing AF at the age of 55 years was 23.8 percent in men and 22.2 percent in women.

Although the lifetime risk of AF for the studied population is lower than in studies of primarily Caucasian patients, the prevalence of AF in Taiwan is projected to rise to just over 4 percent by 2050. According to the investigators, this will result in over 730,000 patients with AF in Taiwan. Because AF is a risk factor for death and other adverse events, researchers analyzed the annual risks for patients with AF and the relative risk ratios compared with patients without AF. They determined that within this population, the annual risks were 9.17 percent for mortality, 8.53 percent for heart failure, 3.40 percent for ischemic stroke, 2.22 percent for dementia, 1.05 percent for sudden cardiac death, and 0.51 percent for myocardial infarction.

Caption: Annual risks of adverse events of patients with AF and HR compared with patients without AF. This annual risk ranged from 0.51 percent for myocardial infarction to 9.17 percent for mortality. Compared with patients without AF, AF was associated with a 1.56-fold to 3.34-fold increase of various events after the adjustment for age, sex, and comorbidities.

“Further, in the present study, we demonstrated that the risk of adverse events in patients with AF remained similar and did not decrease over the study period, despite improvements in our understanding and management of AF,” explained Dr. Hsieh. “Nonetheless, only around 15 percent of patients with AF received appropriate treatments of stroke prevention according to guideline recommendations in Taiwan.”

Full text of this article and interviews with the authors are available to credentialed journalists upon request; contact Andrea Camino, at 224/521-9513 or acamino@chestnet.org.


About the journal CHEST®

The journal CHEST®, the official publication of the American College of Chest Physicians, features the best in peer-reviewed, cutting-edge original research in the multidisciplinary specialties of chest medicine: pulmonary, critical care and sleep medicine; thoracic surgery; cardiorespiratory interactions; and related disciplines. Published since 1935, it is home to the highly regarded clinical practice guidelines and consensus statements. Readers find the latest research posted in the Online First section each week and access series that provide insight into relevant clinical areas, such as Recent Advances in Chest Medicine; Topics in Practice Management; Pulmonary, Critical Care and Sleep Pearls; Ultrasound Corner; Chest Imaging and Pathology for Clinicians; and Contemporary Reviews. Point/Counterpoint Editorials and the CHEST Podcasts address controversial issues, fostering discussion among physicians. www.chestjournal.org

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