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Some patients with atrial fibrillation (AF), albeit less frequently, may regress from sustained to paroxysmal type. We sought to investigate how the regression of AF is associated with outcomes. Among the AF patients enrolled in the Fushimi AF Registry who were identified as having sustained AF at baseline, conversion of sustained to paroxysmal AF during follow-up was defined as AF regression. Major adverse cardiovascular events (MACE) were defined as a composite of cardiac death, myocardial infarction, ischemic stroke, systemic embolism, or hospitalization due to heart failure. Among 2,261 patients with sustained AF at baseline, AF regression was observed in 214 (9.5%) patients over a median follow-up period of 5.8 years (1.78% per patient-year). The annual incidence of MACE in patients with AF regression was significantly lower than those without (3.47% vs. 6.59% per patient-year, P < 0.001; adjusted hazard ratio [HR], 0.53, 95% confidence interval [CI], 0.38-0.72). Furthermore, AF regression was significantly associated with reduced risk of MACE during and after the regression period from sustained to paroxysmal forms (during regression period: adjusted HR, 0.45; 95% CI, 0.22-0.90; after regression period: adjusted HR, 0.43; 95% CI, 0.26-0.67). The incidence of MACE was comparable between spontaneous regression (35/178: 19.7%) and therapy-associated regression (either receiving catheter ablation or antiarrhythmic drugs before the regression) (7/36: 19.4%) (P=0.98). Regression of AF was associated with a lower incidence of adverse cardiovascular events. The risk of adverse events decreased significantly during the regression period and its reduction level persisted after regression. URL: http://www.umin.ac.jp/ctr/index.htm Unique identifier: UMIN000005834., Competing Interests: Declaration of competing interest Dr. Akao received lecture fees from Pfizer, Bristol-Myers Squibb, Boehringer Ingelheim, Bayer Healthcare, and Daiichi Sankyo. All other authors have reported that they have no relationships relevant to the content of this paper to disclose., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Data regarding the associations of anemia (hemoglobin level <13.0 g/dl in men and <12.0 g/dl in women) with clinical outcomes in patients with atrial fibrillation (AF) remains scarce. This study sought to investigate the associations of anemia with the incidences of stroke or systemic embolism, major bleeding, heart failure (HF) hospitalization, and all-cause mortality including its causes, using the data from a Japanese community-based survey, the Fushimi AF Registry. A total of 4,169 AF patients were divided into the 3 groups, based on the baseline hemoglobin level: no (n = 2,622), mild (11.0 to <13.0 g/dl for men and <12.0 g/dl for women; n = 880), and moderate/severe anemia (<11.0 g/dl; n = 667). During a median follow-up of 1,464 days, the incidences of major bleeding, HF hospitalization, and mortality increased with higher rates of cardiac death, in accordance with anemic severity. On multivariate analyses, the higher risk of moderate/severe anemia, relative to no anemia, for major bleeding remained statistically significant (hazard ratio [HR]: 2.00, 95% confidential interval [CI]: 1.48 to 2.72). The risks of those with anemia, relative to no anemia, for HF hospitalization (mild; HR: 1.87, 95% CI: 1.51 to 2.31, and moderate/severe; HR: 2.02, 95% CI: 1.59 to 2.57) as well as for mortality (mild; HR: 1.80, 95% CI: 1.50 to 2.16, and moderate/severe; HR: 2.95, 95% CI: 2.45 to 3.55) were also higher, but not for stroke/systemic embolism. These relations were consistent, regardless of the use of oral anticoagulants. In conclusion, anemia was associated with higher risks of HF hospitalization, mortality, and major bleeding in AF patients., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Data regarding the relation of the type of atrial fibrillation (AF) to the incidence of cardiac events remain scarce. This study sought to investigate the association of AF type with the incidences of cardiac death and heart failure (HF) hospitalization between paroxysmal and sustained (persistent/permanent) AF in the overall population and in age subgroups (≤74, 75 to 84, and ≥85 years), using the data from a Japanese community-based prospective survey, the Fushimi AF Registry. The participants started to be enrolled since March 2011, and follow-up data were available for 4,304 patients by the end of November 2017. Patients with sustained AF (n = 2,187, 50.8%) had more co-morbidities with higher mean CHA 2 DS 2 -VASc score than those with paroxysmal AF (n = 2,117, 49.2%) (sustained vs paroxysmal: 3.57 ± 1.69 vs 3.17 ± 1.67, p <0.001). During a median follow-up of 1,307 (interquartile range: 709 to 2,156) days, the composite of cardiac death and HF hospitalization occurred more frequently in those with sustained AF (event rate: 5.1 vs 2.8 per 100 person-years; p <0.001). On multivariate analysis, sustained AF was independently associated with higher incidence of this composite end point (adjusted hazard ratio [HR]: 1.35, 95% confidence interval [CI]: 1.12 to 1.63, p = 0.002). In age subgroups, this association was observed only in the younger AF patients (≤74 years) (adjusted HR: 2.03, 95% CI: 1.44 to 2.86, p <0.001), but not in the older subgroups (p = 0.018 for interaction). In conclusion, sustained AF was associated with higher incidence of the composite of cardiac death and HF hospitalization than paroxysmal AF, with different relations seen depending on age subgroups., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Creatinine clearance (CrCl) has been widely used to adjust the dosage of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation (AF) and exclude contraindicated patients. However, there are few available real-world data on the relation between CrCl and adverse clinical outcomes in patients with AF. Therefore, we evaluated the clinical characteristics and adverse events in Japanese patients with AF stratified by CrCl. We categorized patients in the Fushimi AF Registry, a large prospective community-based Japanese cohort of patients with AF, into 3 groups as follows: (1) CrCl <30 ml/min, (2) CrCl 30 to 49 ml/min, and (3) CrCl ≥50 ml/min. We evaluated 3,080 patients after a median follow-up of 1,076 days. Comparing with patients with CrCl ≥50 ml/min, patients with AF with CrCl <30 ml/min showed increased risks of stroke/systemic embolism (SE) (hazard ratio [HR] 1.68; 95% confidence interval [CI] 1.04 to 2.65; p = 0.04) and major bleeding (HR, 2.08; 95% CI 1.23 to 3.39; p = 0.008) after adjustment for prespecified factors. Patients with AF with CrCl <30 ml/min were also associated with higher risks of all-cause death, hospitalization for heart failure, myocardial infarction, or the composite of all-cause death and stroke/SE. However, no excess risk of stroke/SE (HR 1.10; 95% CI 0.76 to 1.58; p = 0.6) or major bleeding (HR 0.98; 95% CI 0.63 to 1.48; p = 0.9) was noted for patients with CrCl 30 to 49 ml/min. In conclusion, Japanese patients with AF with CrCl <30 ml/min were closely associated with adverse clinical events including stroke/SE and major bleeding., (Copyright © 2017 Elsevier Inc. All rights reserved.)