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Background: The impact of catheter ablation (CA) on the long-term clinical outcomes in atrial fibrillation (AF) are unclear due to limited cohort investigations. Methods: The Fushimi AF Registry is a community-based prospective survey of patients with AF in Fushimi-ku, Kyoto, Japan. Of 4465 patients enrolled between March 2011 and July 2019, analyses were performed on 2639 patients (492 patients who underwent CA and 2147 patients who received standard rhythm- and/or rate-control drug therapy at baseline). We compared the baseline characteristics and the incidence of major adverse cardiovascular events (MACE: the composite of cardiovascular death, heart failure hospitalization, myocardial infarction, ischemic stroke or systemic embolism), and all-cause mortality during the follow-up using propensity score matching. Results: After entering 20 covariates in the current matching analysis, 342 patients who underwent CA and 342 matched patients who received drug therapy, with a median follow-up of 1865 days, were included. The patients who underwent CA were significantly associated with lower incidence of MACE (hazard ratio (HR) 0.56, 95% confidential interval (CI) 0.36–0.86; P = 0.0077), and all-cause mortality (HR 0.47, 95% CI 0.29–0.75; P = 0.0016). Conclusion: CA was associated with lower incidences of MACE and all-cause mortality for patients with AF as compared with those who received drug therapy. The most common event of MACE in patients who underwent CA was heart failure hospitalization. Clinical trial registration: URL: http://www.umin.ac.jp/ctr/index.htm Unique identifier: UMIN000005834. [ABSTRACT FROM AUTHOR]

Background: The risk of major bleeding in patients with atrial fibrillation (AF) is stratified by risk scores such as HAS-BLED, ORBIT and ATRIA score. However, data regarding the difference between the risk of intracranial hemorrhage (ICH) and that of extracranial hemorrhage (ECH) in AF patients are limited. Methods: The Fushimi AF Registry, a community-based prospective survey, was designed to enroll all of the AF patients in Fushimi-ku, Kyoto. Fushimi-ku is densely populated with a total population of 283,000 and is assumed to represent a typical urban community in Japan. At present, we have enrolled 4,875 patients from March 2011 to November 2017. Follow-up data were available for 4,325 patients, and the median follow-up period was 1,303days. Results: The mean age was 73.6±10.9 years and 59.6% of the patients were male. During the follow-up period, major bleeding occurred in 300 patients (incidence rate 1.96 per 100 person-years). We compared the clinical backgrounds at baseline between patients with ICH events (ICH; n=101, 2.3% of total) and those with ECH events (ECH; n=199, 4.6% of total). Prevalences of hypertension and dyslipidemia were higher in ECH group than ICH group, but age, gender and prevalences of other comorbidities such as diabetes mellitus, heart failure, stroke, coronary artery disease (CAD), renal dysfunction, previous major bleeding and anemia were comparable between the two groups. In multivariate analyses, incidence of ICH was associated with male gender, age (≥75 years) and previous major bleeding (Figure A), whereas incidence of ECH was associated with age (≥75 years), CAD, severe renal dysfunction and anemia (Figure B). Conclusion: Risk factors of ICH and ECH were distinct in AF patients; male gender and previous major bleeding were associated with ICH, whereas CAD, severe renal dysfunction and anemia were associated with ECH. [ABSTRACT FROM AUTHOR]

Background: Heart failure (HF) is one of the major problems of atrial fibrillation (AF). HF is categorized by ejection fraction (EF) into preserved EF (pEF: EF≥50%), mid-range EF (mrEF: 40≤EF<50%), and reduced EF (rEF: EF<40%). However, data on the incidence and predictors of HF in each group in AF patients were limited. Methods: The Fushimi AF Registry was a community-based prospective survey of AF patients in Fushimi-ku, Kyoto, Japan. We compared the incidence and predictors of HF events (composite of cardiovascular death and HF hospitalization) in patients with pEF, mrEF, and rEF. Results: Of 3,415 patients whose EF data were available, the number of patients with pEF, mrEF, and rEF was 2,988 (87.4%), 240 (7.0%), and 187 (5.5%), respectively. As EF decreased, prevalence of coronary artery disease, valvular heart disease, and cardiomyopathy increased. Prevalence of prior HF (prior hospitalization for HF or having HF symptoms (NYHA≥2)) also increased as EF decreased. Beta-blockers were more often prescribed in the rEF group. During the median follow-up of 1,421 days, 353 patients (11.8%) in the pEF group, 68 (28.3%) in the mrEF group, and 75 (40.1%) in the rEF group developed HF events. In multivariate Cox proportional hazard analysis, prior HF was significantly associated with HF events in all groups. Comorbidities, such as diabetes, coronary artery disease, chronic kidney disease, chronic obstructive pulmonary disease, and anemia, were associated with HF events in the pEF group. Anemia was also associated with HF events in the rEF group. Beta-blocker use was associated with lower incidence of HF events in rEF group (Hazard ratio (HR) [95% confidence interval (CI)], 0.39 [0.23-0.66]), but was associated with higher incidence of HF events in pEF (HR [95%CI], 1.27 [1.01-1.59]) and mrEF group (HR, 1.72 [1.00-2.97]) (Table). Conclusion: Among AF patients, prior HF was the predictor for HF events, irrespective of EF. The effect of beta-blocker on HF might differ according to EF. [ABSTRACT FROM AUTHOR]

Background: Oral anticoagulants (OAC) are effective in preventing stroke in patients with atrial fibrillation (AF), and many AF patients have concomitant vascular diseases. Therefore, they are often given the combination of OAC and anti-platelet drugs (APD) and are exposed to increased risk of bleeding. Purpose: We investigated the clinical characteristics of patients with OAC and the temporal change of OAC therapy from 2011 to 2017 in those patients. Methods: The Fushimi AF Registry was designed to enroll all of the AF patients who visited the participating medical institutions in Fushimi-ku, Kyoto, Japan. Follow-up data including prescription status were available for 4,304 patients from March 2011 to November 2017. Of 4,304 patients, 2,378 patients received OAC at enrollment (521 patients with combination of OAC and APD and 1,857 patients with OAC alone). Results: Patients with combination therapy were older and had higher prevalence of co-morbidities including atherosclerotic disease than those with OAC alone. The combination group had higher CHA2DS2-VASc score than OAC groups. Prescription data in 2011 were available in 1,391 patients. Of 1,391 patients, 360 patients (26%) received combination therapy and 1,031 patients (74%) received OAC alone. The proportion of patients with combination therapy decreased year by year. Prescription data in 2017 were available in 1,272 patients. Of 1,272 patients, 158 patients (12%) received combination therapy. The prescription of non-vitamin K antagonist OAC (NOAC) with off-label underdose was given in a substantial number of patients, and was more in patients receiving combination therapy than those with OAC alone. In addition, the underdose NOAC appeared to increase year by year (figure). Conclusion: In Japanese AF patients with OAC, combination therapy with OAC and APD decreased year by year. Many patients received inappropriate dose of NOAC in Japanese AF patients, especially in patients with combination therapy. [ABSTRACT FROM AUTHOR]

Introduction: Atrial fibrillation (AF) increases the risk of thromboembolism, and oral anticoagulants (OAC) are highly effective in preventing it. However, the risk of bleeding is also high in the elderly, especially in those with renal dysfunction. A recent large-scale population-based cohort study demonstrated the paradoxical increase of thromboembolism in elderly patients with renal dysfunction. Methods: The Fushimi AF Registry is a community-based prospective survey of AF patients in Fushimi-ku, Kyoto, Japan. Follow-up data were available in 4,325 patients, and 2,201 elderly patients (≥75 years) were examined. Those included 1,011 patients with chronic kidney disease (CKD) (estimate glomerular filtration rate(eGFR)<60) and 1,189 patients without CKD. We compared the clinical background and outcomes between patients with and without OAC. Results: In both groups, patients with OAC had tendency to have higher CHA2DS2-VASc score and lower HAS-BLED score, compared to those without OAC. The prevalence of heart failure (HF), stroke/systemic embolism (SE), and hypertension (HTN), and male gender were independently associated with OAC use, and high HAS-BLED score (≥3), severe CKD (eGFR<30) and advanced age ≥85 were associated with the absence of OAC in multivariable logistic regression analyses. During the median follow-up of 1,450 days, all-cause mortality was lower in patients with OAC in both groups, and ischemic stroke/SE and MB were similar between the two groups irrespective of the presence of CKD. Conclusions: In elderly Japanese AF patients, OAC use was not associated with the incidence of ischemic stroke/SE or MB, irrespective of the presence of CKD. [ABSTRACT FROM AUTHOR]

Background: The risk of clinical events in patients with atrial fibrillation (AF) were commonly stratified by the scheme based on the disease subtype, such as CHA2DS2-VASc score. However, this stratification did not always represent the heterogeneity of AF. Methods: The Fushimi AF Registry, a community-based prospective survey, was designed to enroll all of the AF patients in Fushimi-ku, Kyoto. Follow-up data including prescription status were available for 4,304 patients (mean age; 73.6 years, female; 40.3%, mean CHA2DS2-VASc score; 3.37). We performed hierarchical cluster analysis, using 42 baseline clinical characteristics. Results: On hierarchical cluster analysis, AF patients were classified into 6 statistically driven clusters: (1) those at younger ages (mean age of 48.3 years) with low rates of risk factors and comorbidities (n=209); (2) those at older ages (mean age of 74.0 years) with low rates of risk factors and comorbidities (n=1,301); (3) those with high rate of atherosclerotic risk factors, such as smoking behavior, hypertension, and diabetes mellitus, but without atherosclerotic disease (n=1,411); (4) those with prior coronary artery disease, myocardial infarction, and/or atherosclerotic comorbidities (n=440); (5) those with history of any-cause stroke (n=681); (6) those in the very elderly (mean age of 83.4 years) (n=262). The incidences of all-cause mortality and major adverse cardiovascular or neurological events (MACNE) were stratified by 6 identified AF clusters (log-rank test; p<0.001 and p<0.001, respectively) (Figure). Conclusion: We identified 6 clinically relevant phenotypes of AF patients on cluster analysis. These phenotypes were associated with the incidence of clinical outcomes in Japanese AF patients. [ABSTRACT FROM AUTHOR]