Typical, atypical, and asymptomatic presentations of new-onset atrial fibrillation in the community

Characteristics and prognostic implications

Konstantinos C. Siontis, Bernard J. Gersh, Jill M. Killian, Peter Noseworthy, Pamela McCabe, Susan A. Weston, Veronique Lee Roger, Alanna Chamberlain

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

Background: The prognostic significance of the clinical presentation of atrial fibrillation (AF) is poorly defined. Objective: The purpose of this study was to determine the frequency, associations, and prognostic impact of different clinical presentations of new-onset AF. Methods: One thousand patients with incident AF in Olmsted County, Minnesota, were randomly selected (2000-2010). Patients with AF that was complicated at presentation (heart failure [n = 71], thromboembolism [n = 24]), provoked (n = 346), or unable to determine symptoms (n = 83) were excluded. In the remaining patients, characteristics and prognosis associated with different types of symptoms were examined. Results: Among 476 patients, 193 had typical (palpitations), 122 had atypical (other non-palpitation symptoms), and 161 had asymptomatic AF presentation. Patients with typical presentation had lower CHA2DS2-VASc scores (mean 2.3 ± 2) compared to atypical and asymptomatic presentation (mean 3.2 ± 1.8 and 3.3 ± 1.9, respectively; P 2DS2-VASc score and age (hazard ratio [HR] 3.51, 95% confidence interval [CI] 1.65-7.48, and HR 2.70, 95% CI 1.29-5.66, respectively), and associations remained statistically significant after further adjustments including comorbidities and warfarin use. Asymptomatic AF was associated with an increased risk of cardiovascular (HR 3.12, 95% CI 1.50-6.45) and all-cause mortality (HR 2.96, 95% CI 1.89-4.64) compared to typical AF after adjustment for CHA2DS2-VASc score and age. Conclusion: The type of clinical presentation may have important implications for the prognosis of new-onset AF in the community.

Original languageEnglish (US)
JournalHeart Rhythm
DOIs
StateAccepted/In press - 2016

Fingerprint

Atrial Fibrillation
Confidence Intervals
Thromboembolism
Warfarin
Comorbidity
Heart Failure
Mortality

Keywords

  • Atral fibrillation
  • Clinical presentation
  • Palpitations
  • Prognosis
  • Stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Typical, atypical, and asymptomatic presentations of new-onset atrial fibrillation in the community : Characteristics and prognostic implications. / Siontis, Konstantinos C.; Gersh, Bernard J.; Killian, Jill M.; Noseworthy, Peter; McCabe, Pamela; Weston, Susan A.; Roger, Veronique Lee; Chamberlain, Alanna.

In: Heart Rhythm, 2016.

Research output: Contribution to journalArticle

@article{b4eed8c9f0214cb28144799fb3854143,
title = "Typical, atypical, and asymptomatic presentations of new-onset atrial fibrillation in the community: Characteristics and prognostic implications",
abstract = "Background: The prognostic significance of the clinical presentation of atrial fibrillation (AF) is poorly defined. Objective: The purpose of this study was to determine the frequency, associations, and prognostic impact of different clinical presentations of new-onset AF. Methods: One thousand patients with incident AF in Olmsted County, Minnesota, were randomly selected (2000-2010). Patients with AF that was complicated at presentation (heart failure [n = 71], thromboembolism [n = 24]), provoked (n = 346), or unable to determine symptoms (n = 83) were excluded. In the remaining patients, characteristics and prognosis associated with different types of symptoms were examined. Results: Among 476 patients, 193 had typical (palpitations), 122 had atypical (other non-palpitation symptoms), and 161 had asymptomatic AF presentation. Patients with typical presentation had lower CHA2DS2-VASc scores (mean 2.3 ± 2) compared to atypical and asymptomatic presentation (mean 3.2 ± 1.8 and 3.3 ± 1.9, respectively; P 2DS2-VASc score and age (hazard ratio [HR] 3.51, 95{\%} confidence interval [CI] 1.65-7.48, and HR 2.70, 95{\%} CI 1.29-5.66, respectively), and associations remained statistically significant after further adjustments including comorbidities and warfarin use. Asymptomatic AF was associated with an increased risk of cardiovascular (HR 3.12, 95{\%} CI 1.50-6.45) and all-cause mortality (HR 2.96, 95{\%} CI 1.89-4.64) compared to typical AF after adjustment for CHA2DS2-VASc score and age. Conclusion: The type of clinical presentation may have important implications for the prognosis of new-onset AF in the community.",
keywords = "Atral fibrillation, Clinical presentation, Palpitations, Prognosis, Stroke",
author = "Siontis, {Konstantinos C.} and Gersh, {Bernard J.} and Killian, {Jill M.} and Peter Noseworthy and Pamela McCabe and Weston, {Susan A.} and Roger, {Veronique Lee} and Alanna Chamberlain",
year = "2016",
doi = "10.1016/j.hrthm.2016.03.003",
language = "English (US)",
journal = "Heart Rhythm",
issn = "1547-5271",
publisher = "Elsevier",

}

TY - JOUR

T1 - Typical, atypical, and asymptomatic presentations of new-onset atrial fibrillation in the community

T2 - Characteristics and prognostic implications

AU - Siontis, Konstantinos C.

AU - Gersh, Bernard J.

AU - Killian, Jill M.

AU - Noseworthy, Peter

AU - McCabe, Pamela

AU - Weston, Susan A.

AU - Roger, Veronique Lee

AU - Chamberlain, Alanna

PY - 2016

Y1 - 2016

N2 - Background: The prognostic significance of the clinical presentation of atrial fibrillation (AF) is poorly defined. Objective: The purpose of this study was to determine the frequency, associations, and prognostic impact of different clinical presentations of new-onset AF. Methods: One thousand patients with incident AF in Olmsted County, Minnesota, were randomly selected (2000-2010). Patients with AF that was complicated at presentation (heart failure [n = 71], thromboembolism [n = 24]), provoked (n = 346), or unable to determine symptoms (n = 83) were excluded. In the remaining patients, characteristics and prognosis associated with different types of symptoms were examined. Results: Among 476 patients, 193 had typical (palpitations), 122 had atypical (other non-palpitation symptoms), and 161 had asymptomatic AF presentation. Patients with typical presentation had lower CHA2DS2-VASc scores (mean 2.3 ± 2) compared to atypical and asymptomatic presentation (mean 3.2 ± 1.8 and 3.3 ± 1.9, respectively; P 2DS2-VASc score and age (hazard ratio [HR] 3.51, 95% confidence interval [CI] 1.65-7.48, and HR 2.70, 95% CI 1.29-5.66, respectively), and associations remained statistically significant after further adjustments including comorbidities and warfarin use. Asymptomatic AF was associated with an increased risk of cardiovascular (HR 3.12, 95% CI 1.50-6.45) and all-cause mortality (HR 2.96, 95% CI 1.89-4.64) compared to typical AF after adjustment for CHA2DS2-VASc score and age. Conclusion: The type of clinical presentation may have important implications for the prognosis of new-onset AF in the community.

AB - Background: The prognostic significance of the clinical presentation of atrial fibrillation (AF) is poorly defined. Objective: The purpose of this study was to determine the frequency, associations, and prognostic impact of different clinical presentations of new-onset AF. Methods: One thousand patients with incident AF in Olmsted County, Minnesota, were randomly selected (2000-2010). Patients with AF that was complicated at presentation (heart failure [n = 71], thromboembolism [n = 24]), provoked (n = 346), or unable to determine symptoms (n = 83) were excluded. In the remaining patients, characteristics and prognosis associated with different types of symptoms were examined. Results: Among 476 patients, 193 had typical (palpitations), 122 had atypical (other non-palpitation symptoms), and 161 had asymptomatic AF presentation. Patients with typical presentation had lower CHA2DS2-VASc scores (mean 2.3 ± 2) compared to atypical and asymptomatic presentation (mean 3.2 ± 1.8 and 3.3 ± 1.9, respectively; P 2DS2-VASc score and age (hazard ratio [HR] 3.51, 95% confidence interval [CI] 1.65-7.48, and HR 2.70, 95% CI 1.29-5.66, respectively), and associations remained statistically significant after further adjustments including comorbidities and warfarin use. Asymptomatic AF was associated with an increased risk of cardiovascular (HR 3.12, 95% CI 1.50-6.45) and all-cause mortality (HR 2.96, 95% CI 1.89-4.64) compared to typical AF after adjustment for CHA2DS2-VASc score and age. Conclusion: The type of clinical presentation may have important implications for the prognosis of new-onset AF in the community.

KW - Atral fibrillation

KW - Clinical presentation

KW - Palpitations

KW - Prognosis

KW - Stroke

UR - http://www.scopus.com/inward/record.url?scp=84964685793&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84964685793&partnerID=8YFLogxK

U2 - 10.1016/j.hrthm.2016.03.003

DO - 10.1016/j.hrthm.2016.03.003

M3 - Article

JO - Heart Rhythm

JF - Heart Rhythm

SN - 1547-5271

ER -