Abstract 15185: The Pattern of Atrial Fibrillation is Relevant to Predicting Thromboembolic Risk - is It Time to Rethink Risk Scores?

Introduction: Atrial fibrillation (AF) is a major cause of stroke and premature death. Current AHA/ESC guidelines define subtypes of AF but these are not incorporated into risk scores of the complications of AF. Aims: To compare all cause mortality, ischaemic stroke and systemic thromboembolism in patients categorised by AF type (paroxysmal, persistent and permanent). Methods: Electronic searches were performed using Medline, PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews up until November 15, 2017. Results: Eleven studies with a total of 81030 patients were included for analyses, comprising 26753 paroxysmal, 18098 persistent and 36179 permanent AF patients. There were no baseline differences in gender and hypertension but diabetes, heart failure, previous stroke and CHADS score were different between subtypes and highest in permanent AF. The risk of ischemic stroke was higher in permanent compared with paroxysmal or persistent AF (permanent vs. paroxysmal: RR = 1.34, 95% CI: 1.12-1.59, p = 0.001; permanent vs. persistent: RR = 1.44, 95% CI: 1.22-1.69, p < 0.001; Fig. 1). A similar result was seen for systemic embolism. All-cause mortality was significantly higher in permanent compared with paroxysmal AF (RR = 1.62, 95% CI: 1.37-1.9, p < 0.001), and trended higher for permanent compared with persistent AF (RR = 1.51, 95% CI: 0.94-2.44, p = 0.09). Conclusion: Permanent AF, compared with paroxysmal and persistent AF, is associated with increased risk of ischemic stroke, systemic embolism and mortality. Our findings have implications for incorporation of AF duration and subtype into stroke risk assessment, as well as the development of therapies to halt and reverse progression of AF. Figure 1. Rate of ischaemic strokes comparing A) permanent vs. persistent AF; B) permanent vs. paroxysmal AF. AF = atrial fibrillation. [ABSTRACT FROM AUTHOR]