Cardiologist Care Reduces Incipient AF Mortality

Specialist care associated is associated with a significantly lower death rate in patients newly diagnosed with atrial fibrillation (AF), according to a new study.

Researchers at the University of Toronto (Canada), the Institute for Clinical Evaluative Sciences (ICES; Toronto, Canada), and other institutions conducted a retrospective study of adult patients with new-onset AF in Ontario (Canada) from 2010 to 2012, in order to assess the association between cardiologist care and clinical outcomes. Patients who saw a cardiologist within one year of initial diagnosis were matched to patients who did not. Main outcomes and measures included death, hospitalization for AF, stroke syndromes, bleeding, and heart failure.

The results revealed that the majority (85%) of new-onset AF patients saw a cardiologist within the year. Cardiologist care within the first year of diagnosis was associated with a lower rate of death (5.3% versus 7.7%) than in those who did not seek care, despite increased hospitalizations for AF (17.9% versus 8.2%), stroke syndromes (1.7% versus 0.5%), bleeding (3.1% versus 2.0%), and heart failure (3.2% versus 1.4%). The results indicate that one in 15 patients with new-onset AF died within a year of the diagnosis. The study was published in the December 2017 issue of the Canadian Journal of Cardiology.

“Variations in AF care across medical specialties are well known. Other than stroke prevention therapy, no other therapy has been associated with improved survival in patients with AF,” said lead author cardiologist Sheldon Singh, MD, of the University of Toronto. “Heart failure and sudden death account for 35-50% of AF deaths, so we hypothesized that comprehensive cardiovascular care beyond stroke prevention may improve overall survival in AF patients.”

“The most startling finding from this study is the high rate of death in the cohort overall. Therefore, a new diagnosis of AF, while not immediately life-threatening, should be regarded as an important marker of near-term risk of cardiovascular events,” commented Stephen Wilton, MD, of the Libin Cardiovascular Institute of Alberta (Calgary, Canada), in an accompanying editorial. “This observation alone provides a potential rationale for desiring early cardiovascular specialist evaluation for these patients.”

AF occurs when the heart's two upper chambers beat erratically. In one form, paroxysmal AF, patients have bouts of erratic beats that begin spontaneously and usually last less than a week. It can lead to serious adverse events such as thrombi traveling from the heart to obstruct arteries supplying the brain, causing stroke, or other parts of the body causing tissue damage.

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University of Toronto
Institute for Clinical Evaluative Sciences