Patients with resolved AF continue to have stroke risk : BMJ

Patients with resolved atrial fibrillation remain at higher risk of stroke or transient ischemic attack (TIA) than patients without atrial fibrillation, according to a study published in the journal The BMJ. The risk is increased even more in the patients who do not have any incidences of recurrent atrial fibrillation.

The study is conducted by Nicola J Adderley, a research fellow at Institute of Applied Health Research, University of Birmingham, and colleagues to determine rates of stroke or TIA and all-cause mortality in patients with a diagnosis of “resolved” atrial fibrillation compared to patients with unresolved atrial fibrillation and without atrial fibrillation.

Atrial fibrillation (AF) is the most common heart rhythm disturbance, affecting millions of people around the world. Those with AF may be aware of noticeable heart palpitations, where their heart feels like it's pounding, fluttering or beating irregularly. Sometimes atrial fibrillation does not cause any symptoms and a person who has it is completely unaware that their heart rate is irregular.

People with AF are more susceptible to strokes and development of blood clots. To avoid strokes it becomes necessary for them to take drugs for prevention of blood clotting. Sometimes AF seems to go away and the heart goes back to its normal rhythm -the condition may then be deemed to have 'resolved'. Up until now, it has been unclear as to whether the clot-prevention drugs can be safely stopped when the condition is 'resolved'.

But the recent research has found that people whose heart rhythm returns to normal continue to be at high risk of stroke and should continue to be treated.

For the study, the researchers looked at patient records from 640 general practices throughout the UK and compared the frequency of strokes in three groups of people: those with ongoing AF; those whose records said that AF had resolved; and those who never had AF.

Dr. Adderley said: "What we found was that strokes were least common in people who never had atrial fibrillation, and much more common in people whose records said their atrial fibrillation had been resolved."

Findings:

• Adjusted incidence rate ratios for stroke or TIA in patients with resolved AF were 0.76 versus controls with atrial fibrillation and 1.63 versus controls without AF.


• Adjusted incidence rate ratios for mortality in patients with resolved AF were 0.60 versus controls with AF and 1.13 versus controls without AF.


• When patients with resolved AF and documented recurrent AF were excluded, the adjusted incidence rate ratio for stroke or TIA was 1.45 versus controls without AF.


• While most people deemed to have AF as an ongoing condition continue to get the clot-prevention drugs they need, the vast majority of those whose AF had 'resolved' do not.

Dr Krish Nirantharakumar, of the University of Birmingham's Institute of Applied Health Research, added: "Our research demonstrates that although people with resolved atrial fibrillation continue to be at high risk of stroke, they are not getting their prevention drugs."

Based on the research, the authors concluded that the patients with resolved AF remain at higher risk of stroke or TIA than patients without atrial fibrillation and the risk is increased even in those in whom recurrent AF is not documented.

For further information click on the link: 10.1136/bmj.k1717