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

36 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

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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

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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.",
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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

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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

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