Prevalence, clinical profile, and cardiovascular outcomes of atrial fibrillation patients with atherothrombosis. Obesity and outcomes among patients with established atrial fibrillation. Focused 2012 update of the Canadian Cardiovascular Society atrial fibrillation guidelines: recommendations for stroke prevention and rate/rhythm control. Relation of Nonvalvular Atrial Fibrillation to Body Mass Index (from the SPORTIF Trials). Risks of cardiovascular events and effects of routine blood pressure lowering among patients with type 2 diabetes and atrial fibrillation: results of the ADVANCE study. Prevalence of atrial fibrillation in elderly subjects (the Cardiovascular Health Study). Association of Anti–Heat Shock Protein 65 Antibodies With Development of Postoperative Atrial Fibrillation Atrial fibrillation is independently associated with senile, vascular, and Alzheimer's dementia. Combined impact of healthy lifestyle factors on risk of atrial fibrillation: Prospective study in men and women. Randomized trial of rate-control versus rhythm-control in persistent atrial fibrillation: the Strategies of Treatment of Atrial Fibrillation (STAF) study. Risk factors for atrial fibrillation and their population burden in postmenopausal women: the Women's Health Initiative Observational Study Atrial fibrillation: the rate versus rhythm management controversy. Optimal treatment strategy for patients with paroxysmal atrial fibrillation: J-RHYTHM Study. Hemostatic state and atrial fibrillation (the Framingham Offspring Study). Anemia and reduced kidney function as risk factors for new onset of atrial fibrillation (from the Ibaraki prefectural health study). Clinical predictors of atrial fibrillation recurrence in the Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico-Atrial Fibrillation (GISSI-AF) trial. Close bidirectional relationship between chronic kidney disease and atrial fibrillation: the Niigata preventive medicine study. Gender-specific relationship between serum uric acid level and atrial fibrillation prevalence. The long- and short-term impact of elevated body mass index on the risk of new atrial fibrillation the WHS (women's health study). Long-term cardiovascular outcomes in patients with atrial fibrillation and atherothrombosis in the REACH Registry. Validation of the Risk Estimator Decision Aid for Atrial Fibrillation (RED-AF) for predicting 30-day adverse events in emergency department patients with atrial fibrillation. Hyperuricemia and the risk of ischemic stroke in patients with atrial fibrillation--could it refine clinical risk stratification in AF? Development of a Basic Risk Score for Incident Atrial Fibrillation in a Japanese General Population　- The Suita Study. Thromboembolism prophylaxis in chronic atrial fibrillation. Practice patterns in community and tertiary-care hospitals. Probing oral anticoagulation in patients with atrial high rate episodes: Rationale and design of the Non–vitamin K antagonist Oral anticoagulants in patients with Atrial High rate episodes (NOAH–AFNET 6) trial Risk of Malignant Cancer Among Women With New-Onset Atrial Fibrillation. Distribution and Risk Profile of Paroxysmal, Persistent, and Permanent Atrial Fibrillation in Routine Clinical Practice: Insight From the Real-Life Global Survey Evaluating Patients With Atrial Fibrillation International Registry Factors affecting bleeding risk during anticoagulant therapy in patients with atrial fibrillation: observations from the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study. The ORBIT bleeding score: a simple bedside score to assess bleeding risk in atrial fibrillation Evaluation of the safety and efficacy of an edoxaban‐based antithrombotic regimen in patients with atrial fibrillation following successful percutaneous coronary intervention (PCI) with stent placement: Rationale and design of the ENTRUST‐AF PCI trial Atrial fibrillation postcardiac surgery: a common but a morbid complication. Acute myocardial infarction in patients with atrial fibrillation with a CHA2DS2-VASc score of 0 or 1: a nationwide cohort study. A randomised controlled trial and cost effectiveness study of systematic screening (targeted and total population screening) versus routine practice for the detection of atrial fibrillation in the over 65s: (SAFE) [ISRCTN19633732] Incidence of chronic atrial fibrillation in general practice and its treatment pattern.
BACKGROUND Atrial fibrillation ( AF ) is a major risk factor ( RF ) for ischemic stroke . Its prevalence and prognostic impact in patients with atherothrombosis are unclear . METHODS Risk factors , drug usage , and 1-year cardiovascular ( CV ) outcomes ( CV death , myocardial infa rct ion [ MI ] , and stroke ) were compared in  AF and non-AF patients from the REduction of Atherothrombosis for Continued Health ( REACH ) Registry , an international , prospect i ve cohort of 68,236 stable out patients with established atherothrombosis or > or=3 atherothrombotic RFs . RESULTS Atrial fibrillation and 1-year follow-up data are available for 63,589 patients . The prevalence of AF was , 12.5 % , 13.7 % , 11.5 % , and 6.2 % among coronary artery disease , CV disease , peripheral artery disease , and RF-only patients , respectively . Of the 6,814 patients with AF , 6.7 % experienced CV death , nonfatal MI , or nonfatal stroke within a year . The annual incidence of nonfatal stroke ( 2.4 % vs 1.6 % , P<.0001 ) and unstable angina ( 6.0 % vs 4.0 % , P<.00001 ) was higher , and CV death was more than double ( 3.2 % vs 1.4 % , P<.0001 ) , in AF versus non-AF patients . In these patients with or at high risk of atherothrombosis , most patients with AF received antiplatelet agents , but only 53.1 % were treated with oral anticoagulants . Even with high CHADS2 ( congestive heart failure , hypertension , aging , diabetes mellitus , and stroke ) scores , anticoagulant use did not exceed ( 59 % ) . The rate of bleeding requiring hospitalization was higher in AF versus non-AF patients ( 1.5 % vs 0.8 % , P<.0001 ) , possibly related to the more frequent use of anticoagulants ( 53.1 % vs 7.1 % ) . CONCLUSIONS Atrial fibrillation is common in patients with atherothrombosis , associated with more frequent fatal and nonfatal CV outcomes , and underuse of oral anticoagulants Atrial fibrillation ( AF ) and obesity have reached epidemic proportions . The impact of obesity on clinical outcomes in patients with established AF is unknown . We analyzed 2,492 patients in the Atrial Fibrillation Follow-Up Investigation of Rhythm Management ( AFFIRM ) study .  Body mass index ( BMI ) was evaluated as a categorical variable ( normal 18.5 to < 25 kg/m(2 ) , overweight 25 to < 30 kg/m(2 ) , obese > or=30 kg/m(2 ) ) . Rate of death from any cause was higher in the normal BMI group ( 5.8 per 100 patient-years ) than in the overweight and obese groups ( 3.9 and 3.7 , respectively ) . Cardiovascular death rate was highest in the normal BMI group ( 3.1 per 100 patient-years ) , lowest in the overweight group ( 1.5 per 100 patient-years ) , and intermediate in the obese group ( 2.1 per 100 patient-years ) . After adjustment for baseline factors , differences in risk of death from any cause were no longer significant . However , overweight remained associated with a lower risk of cardiovascular death ( hazard ratio 0.47 , p = 0.002 ) . Obese patients were more likely to have an uncontrolled heart rate at rest , but rhythm-control strategy success was similar across BMI categories . In each BMI category , risk of death from any cause was similar for patients r and omized to a rhythm- or rate-control strategy . In conclusion , in patients with established AF , overweight and obesity do not adversely affect overall survival . Obesity does not appear to affect the relative benefit of a rate- or rhythm-control strategy The Canadian Cardiovascular Society ( CCS ) published the complete set of 2010 Atrial Fibrillation ( AF ) Guidelines in the January , 2011 issue of the Canadian Journal of Cardiology . During its deliberations , the CCS Guidelines Committee engaged to a timely review of future evidence , with periodic composition of focused up date s to address clinical ly important advances . In 2011 , results were published from 3 pivotal AF trials : the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonist for Prevention of Stroke and Embolism Trial in Atrial Fibrillation ( ROCKET-AF ) , the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation ( ARISTOTLE ) study , and the Permanent Atrial Fibrillation Outcome Study Using Dronedarone on Top of St and ard Therapy ( PALLAS ) , comparing dronedarone with placebo in patients with permanent AF and additional cardiovascular disease risk-factor burden . Each of these large r and omized trials provided clear results with major implication s for AF management . Other important evidence that has emerged since the 2010 Guidelines includes findings about prediction instruments for AF-associated stroke and bleeding risk , stroke risk in paroxysmal-AF patients , risk-benefit considerations related to oral anticoagulation in patients with chronic kidney disease , and risk/benefit considerations in the use of antiplatelet agents , alone and in combination with each other or with oral anticoagulants , in AF patients . The Guidelines Committee judged that this extensive and important new evidence required focused updating of the 2010 Guidelines with respect to stroke prevention and rate/rhythm control . This report presents the details of the new recommendations , along with the background and rationale Obesity is well-established as a major cardiovascular ( CV ) risk factor . Obesity confers a greater risk for developing atrial fibrillation ( AF ) , but the relation between obesity and established nonvalvular AF for stroke and all-cause death is still unclear . To ascertain the prevalence of overweight and obesity in patients with nonvalvular AF , their influence on adverse events , and the relation with anticoagulation control , we performed this post hoc analysis of the pooled Stroke Prevention using an Oral Thrombin Inhibitor in patients with atrial Fibrillation ( SPORTIF ) III and V data sets . For this study , we analyzed all patients assigned to the warfarin arm with data on body mass index ( BMI ) . Time in therapeutic range was used as an index of the quality of anticoagulation control . The 3,630 patients eligible for this analysis were categorized as follows : ( 1 ) BMI 18.5 to 24.9 ( " normal weight " ) in 24.1 % ; ( 2 ) BMI 25.0 to 29.9 ( " overweight " ) in 39.8 % ; and BMI ≥30 ( " obese " ) in 36.1 % . Both overweight ( hazard ratio [ HR ] 0.70 ) and obese ( HR 0.59 ) categories were inversely associated with the composite outcome of stroke/all-cause death . A similar inverse association was seen for the end point of stroke ( HR 0.61 and 0.47 , respectively ) . Good anticoagulation control also attenuated the association between BMI categories and outcomes . In patients with time in therapeutic range > 70 % , BMI category was not significantly associated with the composite outcome of stroke/death and stroke . Stroke and all-cause death progressively reduced in overweight and obese anticoagulated patients with AF . The inverse relation of BMI categories to the risk of stroke and all-cause death was mitigated by good anticoagulation control AIMS The aim of this study was to investigate serious clinical outcomes associated with atrial fibrillation ( AF ) and the effects of routine blood pressure lowering on such outcomes in the presence or absence of AF , among individuals with type 2 diabetes . METHODS AND RESULTS About 11 140 patients with type 2 diabetes ( 7.6 % of whom had AF at baseline ) were r and omized to a fixed combination of perindopril and indapamide or placebo in the Action in Diabetes and Vascular Disease : preterAx and diamicroN-MR Controlled Evaluation ( ADVANCE ) study . We compared total mortality and cardiovascular disease outcomes and effects of r and omized treatment for 4.3 years on such outcomes between patients with and without AF at baseline . After multiple adjustments , AF was associated with a 61 % ( 95 % confidence interval 31 - 96 , P < 0.0001 ) greater risk of all-cause mortality and comparable higher risks of cardiovascular death , stroke , and heart failure ( all P < 0.001 ) . Routine treatment with a fixed combination of perindopril and indapamide produced similar relative , but greater absolute , risk reductions for all-cause and cardiovascular mortalities in patients with AF , compared with those without AF . The number of patients needed to be treated with perindopril-indapamide for 5 years to prevent one cardiovascular death was 42 for patients with AF and 120 for patients without AF at baseline . CONCLUSION Atrial fibrillation is relatively common in type 2 diabetes and is associated with substantially increased risks of death and cardiovascular events in patients with type 2 diabetes . This arrhythmia identifies individuals who are likely to obtain greater absolute benefits from blood pressure-lowering treatment . Atrial fibrillation in diabetic patients should be regarded as a marker of particularly adverse outcome and prompt aggressive management of all risk factors Atrial  fibrillation ( AF ) is a common arrhythmia in elderly persons and a common cause of embolic stroke . Most studies of the prevalence and correlates of AF have used selected , hospital-based population s. The Cardiovascular Health Study is a population -based , longitudinal study of risk factors for coronary artery disease and stroke in 5,201 men and women aged > or = 65 years .  AF  was diagnosed in 4.8 % of women and in 6.2 % of men at the baseline examination , and prevalence was strongly associated with advanced age in women . Prevalence of AF  was 9.1 % in men and women with clinical cardiovascular disease , 4.6 % in patients with evidence of sub clinical but no clinical cardiovascular disease , and only 1.6 % in subjects with neither clinical nor sub clinical cardiovascular disease . A history of congestive heart failure , valvular heart disease and stroke , echocardiographic evidence of enlarged left atrial dimension , abnormal mitral or aortic valve function , treated systemic hypertension , and advanced age were independently associated with the prevalence of AF .  The low prevalence of AF in the absence of clinical and sub clinical cardiovascular disease calls into question the existence and clinical usefulness of the concept of so-called " lone atrial fibrillation " in the elderly Background —Atrial fibrillation ( AF ) is a frequently encountered arrhythmia after cardiac surgery , but its underlying mechanisms are still unclear . We hypothesize that autoimmune and inflammatory responses against heat shock protein 65 ( HSP65 ) may be involved and hence examined the relationship between HSP65 autoantibodies and occurrence of postoperative AF . Methods and Results —A prospect i ve study of 329 patients undergoing elective primary CABG was undertaken .  Cardiovascular risk factors , ECG characteristics , medications , and intraoperative and postoperative features were documented . Anti-HSP65 antibodies and C-reactive protein levels were measured in all preoperative blood sample s with ELISA .  Postoperative AF was defined as the characteristic arrhythmia , lasting for at least 15 minutes and confirmed on 12-lead ECG and occurring within the first postoperative week . This occurred in 62 patients ( 19 % ) . In univariate analysis , HSP65 antibodies were significantly higher in patients with postoperative AF ( P=0.02 ) . History of previous myocardial infa rct ion , duration of bypass , number of distal anastomosis , and duration of ventilation were also associated with AF ( P<0.05 ) , but C-reactive protein levels were not ( P=0.13 ) . Multivariate analysis confirmed the positive association of HSP65 antibodies with postoperative AF ( OR , 1.41 ; P=0.04 ) independent of age , sex , other cardiovascular risk factors , severity of coronary artery disease , duration of ventilation , duration of bypass , and left ventricular function . Conclusions —We report a novel association between anti-HSP65 antibodies and occurrence of postoperative AF , indicating a possible role for antibody-mediated immune response in its pathogenesis BACKGROUND The aging population has result ed in more patients living with cardiovascular disease , such as atrial fibrillation ( AF ) . Recent focus has been placed on underst and ing the long-term consequences of chronic cardiovascular disease , such as a potential increased risk of dementia . OBJECTIVE This study sought to determine whether there is an association between AF and dementia and whether their coexistence is an independent marker of risk . METHODS A total of 37,025 consecutive patients from the large ongoing prospect i ve Intermountain Heart Collaborative Study data base were evaluated and followed up for a mean of 5 years for the development of AF and dementia . Dementia was sub-typed into vascular ( VD ) , senile ( SD ) , Alzheimer 's ( AD ) , and nonspecified ( ND ) . RESULTS Of the 37,025 patients with a mean age of 60.6 + /- 17.9 years , 10,161 ( 27 % ) developed AF and 1,535 ( 4.1 % ) developed dementia ( 179 VD , 321 SD , 347 AD , 688 ND ) during the 5-year follow-up . Patients with dementia were older and had higher rates of hypertension , coronary artery disease , renal failure , heart failure , and prior strokes . In age-based analysis , AF independently was significantly associated with all dementia types . The highest risk was in the younger group ( < 70 ) . After dementia diagnosis , the presence of AF was associated with a marked increased risk of mortality ( VD : hazard ratio [ HR ] = 1.38 , P = .01 ; SD : HR = 1.41 , P = .001 ; AD : HR = 1.45 ; ND : HR = 1.38 , P < .0001 ) . CONCLUSION AF was independently associated with all forms of dementia . Although dementia is strongly associated with aging , the highest risk of AD was in the younger group , in support of the observed association . The presence of AF also identified dementia patients at high risk of death BACKGROUND The combined impact of multiple lifestyle factors on risk of atrial fibrillation ( AF )  remains unclear . We investigated the joint association of four modifiable lifestyle factors on incidence of AF in a prospect i ve study of men and women . METHODS The study cohort comprised 39 300 men in the Cohort of Swedish Men and 33 090 women in the Swedish Mammography Cohort who were 45 - 83 years of age and free from atrial fibrillation at baseline . Healthy lifestyle was defined as body mass index < 25 kg/m(2 ) , regular exercise for ≥ 20 min/day , no or light-to-moderate alcohol consumption ( ≤ 2 drinks/day for men and ≤ 1 drink/day for women ) , and not smoking . Incident AF cases were identified through linkage with the Swedish National Inpatient Register . RESULTS During a mean follow-up of 10.9 years , AF occurred in 4028 men and 2539 women . Compared with men and women with no healthy lifestyle factors , the multivariable relative risks ( 95 % confidence interval ) of AF were 0.83 ( 0.65 - 1.07 ) for one , 0.74 ( 0.58 - 0.94 ) for two , 0.62 ( 0.49 - 0.79 ) for three , and 0.50 ( 0.39 - 0.64 ) for four healthy lifestyle factors ( P for trend < 0.0001 ) . The inverse association was similar in men and women . CONCLUSIONS Four healthy lifestyle factors combined were associated with a halving of the risk of AF OBJECTIVES This study was design ed to compare two treatment strategies in patients with atrial fibrillation(AF ) :  rhythm-control ( restoration and maintenance of sinus rhythm ) and rate-control ( pharmacologic or invasive rate-control and anticoagulation ) . BACKGROUND Atrial fibrillation is the most common arrhythmia . It is unclear whether a strategy of rhythm- or rate-control is better in terms of mortality , morbidity , and quality of life . METHODS The Strategies of Treatment of Atrial Fibrillation ( STAF ) multicenter pilot trial r and omized 200 patients ( 100 per group ) with persistent AF to rhythm- or rate-control .  The combined primary end point was a combination of death , cardiopulmonary resuscitation , cerebrovascular event , and systemic embolism . RESULTS After 19.6 + /- 8.9 months ( range 0 to 36 months ) there was no difference in the primary end point between rhythm-control ( 9/100 ; 5.54%/year ) and rate-control ( 10/100 ; 6.09%/year ; p = 0.99 ) . The percentage of patients in sinus rhythm in the rhythm-control group after up to four cardioversions during the follow-up period ( rate-control group ) was 23 % ( 0 % ) at 36 months . Eighteen primary end points occurred in atrial fibrillation ; only one occurred in sinus rhythm ( p = 0.049 ) . CONCLUSIONS The STAF pilot study showed no differences between the two treatment strategies in all end points except hospitalizations . These data suggest that there was no benefit in attempting rhythm-control in these patients with a high risk of arrhythmia recurrence . It remains unclear whether the results in the rhythm-control group would have been better if sinus rhythm had been maintained in a higher proportion of patients , as all but one end point occurred during AF Objective Atrial fibrillation ( AF ) is the most common arrhythmia in women . Large studies evaluating key AF risk factors in older women are lacking . We aim ed to identify risk factors for AF  in postmenopausal women and measure population burden of modifiable risk factors . Design Prospect i ve observational study . Setting The Women 's Health Initiative ( WHI ) Observational Study . Patients 93 676 postmenopausal women were followed for an average of 9.8 years for cardiovascular outcomes . After exclusion of women with prevalent AF or incomplete data , 8252 of the remaining 81 892 women developed incident AF . Main outcome measures Incident AF was identified by WHI-ascertained hospitalisation records and diagnosis codes from Medicare cl aims . Multivariate Cox hazard regression analysis identified independent risk factors for incident AF . Results Age , hypertension , obesity , diabetes , myocardial infa rct ion and heart failure were independently associated with incident AF . Hypertension and overweight status accounted for 28.3 % and 12.1 % , respectively , of the population attributable risk . Hispanic and African – American participants had lower rates of incident AF ( HR 0.58 , 95 % CI 0.47 to 0.70 and HR 0.59 , 95 % CI 0.53 to 0.65 , respectively ) than Caucasians . Conclusions Caucasian ethnicity , traditional cardiovascular risk factors and peripheral arterial disease were independently associated with higher rates of incident AF  in postmenopausal women . Hypertension and overweight status accounted for a large proportion of population attributable risk . Measuring burden of modifiable AF risk factors in older women may help target interventions The fundamental management strategy for atrial fibrillation ( AF ) is still debated . There is no doubt that those patients at risk of thromboembolic events should be offered anticoagulant therapy . However , it is uncertain whether rhythm control ( restoration and maintenance of sinus rhythm ) or rate control ( adjustment to a physiological ventricular rate while allowing AF to continue ) is the preferred primary treatment option for the reduction of symptoms and major cardiovascular ( CV ) outcomes associated with AF . Several well conducted trials comparing the two strategies led to the conclusion that there was little to choose between them . However , guidelines leaned towards recommending rate control as the initial strategy , and reserved rhythm control for those who remained symptomatic . Recently this status quo is being increasingly challenged by the clear demonstration that left atrial catheter ablation is effective at suppressing AF resistant to traditional antiarrhythmic drugs , such as those that failed to demonstrate any superiority when compared with rate control . Also , recently introduced antiarrhythmic therapy may have superior efficacy with regard to reducing unexpected CV hospitalization , CV mortality and stroke . In addition , there is a growing perception that atrial remodelling should be best prevented by early rhythm control rather than delaying until rate control has proven unsatisfactory . For these reasons the results of large r and omised clinical trials , which recruit patients soon after the presentation of AF and compare ' aggressive ' modern rhythm control against the guideline approach of primary rate control , are eagerly awaited . In the meantime the pendulum of clinical opinion has begun to swing towards a rhythm control strategy Background Although previous clinical trials demonstrated the non-inferiority of a rate control to rhythm control strategy for management of atrial fibrillation ( AF ) , the optimal treatment strategy for paroxysmal AF ( PAF ) remains unclear . Methods and Results A r and omized , multicenter comparison of rate control vs rhythm control in Japanese patients with PAF ( the Japanese Rhythm Management Trial for Atrial Fibrillation ( J-RHYTHM ) study ) was conducted . The primary endpoint was a composite of total mortality , symptomatic cerebral infa rct ion , systemic embolism , major bleeding , hospitalization for heart failure , or physical/psychological disability requiring alteration of treatment strategy . In the study , 823 patients with PAF were followed for a mean period of 578 days . The primary endpoint occurred in 64 patients ( 15.3 % ) assigned to rhythm control and in 89 patients ( 22.0 % ) to rate control ( P=0.0128 ) . No significant differences between the treatment strategies were observed in the incidences of death , stroke , bleeding and heart failure . Meanwhile , significantly fewer patients requested changes of assigned treatment strategy in the rhythm control vs the rate control group , which was accompanied by improvement in AF-specific quality of life scores . Conclusion The J-RHYTHM study showed that rhythm control was associated with fewer primary endpoints than rate control . However , mortality and cardiovascular morbidity were not affected by the treatment strategy ( umin-CTR No. C000000106 ) Atrial fibrillation ( AF ) is strongly associated with thromboembolic complications , although the mechanism for the increased risk has not been fully explained . To determine whether AF might be associated with a hypercoagulable state , we studied hemostatic factors in subjects with or without AF in the Framingham Heart Study . In 3,577 subjects , we measured  fibrinogen , von Willebr and factor antigen , tissue plasminogen activator ( tPA ) antigen , and plasminogen activator inhibitor-1 antigen .  Forty-seven subjects had AF at the index clinic examination and 15 had AF on a prior examination , but not on the current examination .  Before matching , the 47 subjects with prevalent AF had higher levels of fibrinogen , von Willebr and factor , and tPA antigen than those without AF , all p < or = 0.03 . Compared with 167 referent subjects matched for age , sex , and other risk factors , those with AF had higher tPA antigen levels than those without AF , 1 1.8 + /- 4.0 ng/ml versus 10.5 + /- 3.9 ng/ml ( p = 0.04 ) . However , when further stratified according to their cardiovascular disease status , the differences in hemostatic factors were no longer significant . We conclude that the prothrombotic profile associated with AF was explained by the risk factors of the subjects and the presence of cardiovascular disease . Nonetheless , the hemostatic changes may contribute toward the propensity for thromboembolic complications in AF . Further prospect i ve studies are needed to evaluate whether measurement of these and other hemostatic factors will identify patients with AF who are at increased risk for thromboembolic complications , and who may therefore benefit from more intensive therapy Chronic kidney disease ( CKD ) is a potential independent risk factor for  atrial fibrillation ( AF ) .  It remains unclear whether anemia is synergistically associated with increased risk of AF onset  in subjects with CKD . We evaluated the association of kidney function , hemoglobin ( Hb ) , and their combination with new-onset AF in a population -based cohort study . We conducted a 15-year prospect i ve cohort study of 132,250 Japanese subjects aged 40 to 79 years who participated in annual health checkups from 1993 .  Kaplan-Meier survival analysis was used to compare freedom from new-onset AF between groups classified by estimated glomerular filtration rate grade , Hb grade , and their combination . Cox proportional hazard model analysis was used to estimate hazard ratios ( HRs ) for new-onset AF . During a 13.8-year mean follow-up period , 1,232 ( 0.93 % ) subjects with  new-onset AF were identified . Lower estimated glomerular filtration rate and lower Hb grade s were significantly associated with a higher incidence of new-onset AF . Multivariate HRs and 95 % confidence intervals ( CIs ) of new-onset AF were 1.38 ( 1.21 to 1.56 ) for mild CKD group , 2.56 ( 2.09 to 3.13 ) for CKD group , and 1.50 ( 1.24 to 1.83 ) for anemia group . Borderline Hb level was not significantly associated with increased risk for new-onset AF ( HR 1.07 , CI 0.91 to 1.25 , p = 0.4284 ) . In the model with interaction term between CKD and anemia , the risk was significantly higher ( p = 0.0343 for the interaction ) than that predicted by each factor independently . In conclusion , decreased kidney function and lower Hb level are associated with increased risk for new-onset AF , especially when both are present BACKGROUND Atrial fibrillation ( AF ) is a common arrhythmia that frequently recurs after restoration of sinus rhythm ( SR ) . Identifying risk factors for recurrence may help define the best strategy for secondary prevention . METHODS The GISSI-AF trial enrolled 1,442 patients in SR with at least 2 documented AF episodes in the previous 6 months or after cardioversion in the last 2 weeks . Patients were r and omized to valsartan or placebo ; all other treatments for AF or underlying heart diseases were allowed . Primary end points were time to first recurrence of AF and proportion of patients with > 1 AF episode during 1-year follow-up . We evaluated  clinical and electrocardiographic baseline characteristics  of all patients to identify independent predictors for AF recurrence using a Cox multivariable model . RESULTS Risk factors for AF recurrence were a history of 2 or more AF episodes in the previous 6 months , independent of the modality of SR restoration , spontaneous ( HR 1.42 , 95 % CI 1.14 - 1.77 , P = .002 ) , or by cardioversion ( HR 1.19 , 95 % CI 1.01 - 1.40 , P = .038 ) , and a lower heart rate during SR ( HR 0.99 , 95 % CI 0.99 - 1.00 , P = .052 ) . The risk factors were the same for > 1 AF recurrence . Patients treated with amiodarone had a lower risk for both end points ( P < .0001 and P = .017 ) , whereas those on diuretics had a greater risk ( P = .009 and P = .003 ) . CONCLUSIONS In the GISSI-AF study population , AF history had significant prognostic value independent of the modality of SR restoration . Amiodarone and diuretic treatment affected the rate of AF recurrence BACKGROUND Atrial fibrillation ( AF ) and chronic kidney disease share risk factors and pathophysiologic mechanisms , suggesting that two conditions have close relationships . METHODS This is a prospect i ve community-based observational cohort study including 235,818 subjects based upon a voluntary annual health check-up program in Japan . We studied the association of kidney dysfunction at entry with subsequent new-onset AF  and the association of AF at entry with the development of kidney disease . RESULTS During a follow-up of 5.9 + /- 2.4 years , AF developed in 2947 subjects ( 1.3 % ) .  Baseline serum creatinine and estimated glomerular filtration rate ( GFR ) were associated with risk of subsequent AF . The HRs ( 95 % CI ) for AF were 1.32 ( 1.08 - 1.62 ) and 1.57 ( 0.89 - 2.77 ) for GFR 30 to 59 and < 30 mL/min per 1.73 m(2 ) , respectively . The effect of kidney disease on risk of new-onset AF remained significant in subjects without treated hypertension or diabetes . During the follow-up , 7791 subjects ( 3.3 % ) developed kidney dysfunction ( GFR < 60 mL/min per 1.73 m(2 ) ) , and 11 307 subjects ( 4.9 % ) developed proteinuria .  Atrial fibrillation at entry was associated with development of kidney dysfunction ( HRs [ 95 % CI ] , 1.77 [ 1.50 - 2.10 ] ) and proteinuria ( HR [ 95 % CI ] , 2.20 [ 1.92 - 2.52 ] ) . The association persisted in subjects without treated hypertension or diabetes . CONCLUSIONS Kidney dysfunction increased the risk of new onset of AF , and AF increased the risk of development of kidney disease . This finding supports the concept that the two conditions share common abnormal molecular signaling pathways contributing to their pathogenesis BACKGROUND Although various kinds of cardiovascular risk factors have been reported to be associated with  atrial fibrillation ( AF )  , the relationship between serum uric acid level and AF has not been fully examined . METHODS AND RESULTS Data were collected from a single hospital-based cohort in the Shinken Data base 2004 - 2008 ( n=11,123 ) , and consisted of serum uric acid level for 7,155 patients . The association between serum uric acid level and AF prevalence was evaluated on logistic regression . Uric acid significantly increased the crude AF prevalence in both men and women ( both , P<0.001 ) . The odds ratio ( OR ) and 95 % confidence interval ( 95%CI ) in the highest tertile compared with the lowest one were 3.368 ( 2.478 - 4.578 ) and 1.408 ( 1.169 - 1.695 ) in women and men , respectively . Uric acid was also significantly associated with other various cardiovascular risk factors for AF . Even after the multivariate model was adjusted using these variables , the effect of uric acid on AF was independent in women ( OR , 1.888 ; 95%CI : 1.278 - 2.790 ) , but not in men . CONCLUSIONS Reflecting the composite of various cardiovascular risk factors , serum uric acid level was apparently associated with AF prevalence . The independent association in women might imply some sex-specific mechanisms . The results should be confirmed in prospect i ve studies OBJECTIVES The purpose of this study was to characterize the relationship between changes in  body mass index ( BMI ) and incident atrial fibrillation ( AF ) in a large cohort of women . BACKGROUND Obesity and AF are increasing public health problems . The importance of dynamic obesity-associated AF risk is uncertain , and mediators are not well characterized . METHODS Cases of AF were confirmed by medical record review in 34,309 participants in the Women 's Health Study . Baseline and up date d measures of  BMI  were obtained from periodic question naires . RESULTS During 12.9 + /- 1.9 years of follow-up , 834 AF events were confirmed . BMI was linearly associated with AF risk , with a 4.7 % ( 95 % confidence interval [ CI ] : 3.4 to 6.1 , p < 0.0001 ) increase in risk with each kilogram per square meter . Adjustment for inflammatory markers minimally attenuated this risk . When up date d measures of BMI were used to estimate dynamic risk , overweight ( hazard ratio [ HR ] : 1.22 ; 95 % CI : 1.02 to 1.45 , p = 0.03 ) , and obesity ( HR : 1.65 ; 95 % CI : 1.36 to 2.00 ; p < 0.0001 ) were associated with adjusted short-term increases in AF risk . Participants becoming obese during the first 60 months had a 41 % adjusted increase in risk of the development of AF ( p = 0.02 ) compared with those maintaining BMI < 30 kg/m(2 ) . The prevalence of overweight and obesity increased over time . The adjusted proportion of incident AF attributable to short-term elevations in BMI was substantial ( 18.3 % ) . CONCLUSIONS In this population of apparently healthy women , BMI was associated with short- and long-term increases in AF risk , accounting for a large proportion of incident AF independent of traditional risk factors . A strategy of weight control may reduce the increasing incidence of AF . ( Women 's Health Study [ WHS ] : A R and omized Trial of Low-Dose Aspirin and Vitamin E in the Primary Prevention of Cardiovascular Disease and Cancer ; NCT00000479 ) BACKGROUND Patients with atrial fibrillation ( AF )  are at increased risk of thromboembolic events . The long-term prognostic implication s of AF in patients with atherothrombosis are unknown . METHODS We compared 4-year CV outcomes in patients with and without a history of AF recorded at their baseline visit in the REACH Registry , an international , prospect i ve cohort of patients with established atherosclerotic arterial disease ( CAD , CVD , PAD ) or at least 3 risk factors ( RFO ) . RESULTS AF status and 4 year follow-up data were available on 44,518 patients . The prevalence of AF at baseline was 10.3 % ( n=4582 ) . Overall , patients with AF had approximately a 2-fold increase in the composite of CV death , MI , or stroke compared with patients without AF after adjustment for age , gender , prior ischemic event , vascular disease , congestive heart failure , diabetes , smoking , body mass index , region , aspirin and statin use ( 18.9 % vs. 9.4 % , p<0.0001 ) . This increased risk was observed both in patients with established atherothrombosis ( CAD : 15.5 % vs. 8.0 % , p=0.0001 ; CVD : 23.6 % vs. 13.6 % , p<0.0001 ; PAD : 24.3 % vs. 13.5 % , p=0.089 ) and those with multiple risk factors ( RFO : 12.1 % vs. 5.9 % , p=0.017 ) . Only 52 % of patients with a history of AF at baseline were receiving anticoagulation at 4 years . CONCLUSIONS Patients with a history of both AF and atherothrombosis have particularly high long-term CV risk . Despite this increased risk , almost half of all patients with AF do not receive guideline recommended anticoagulation , highlighting an important public health priority STUDY OBJECTIVE In the United States , nearly 70 % of emergency department ( ED ) visits for atrial fibrillation result in hospitalization . The incidence of serious 30-day adverse events after an ED evaluation for atrial fibrillation remains low . This study 's goal was to prospect ively vali date our previously reported Risk Estimator Decision Aid for Atrial Fibrillation ( RED-AF ) model for estimating a patient 's risk of experiencing a 30-day adverse event . METHODS This was a prospect i ve cohort study , which enrolled a convenience sample of ED patients presenting with atrial fibrillation .  RED-AF , previously derived from a retrospective cohort of 832 patients , assigns points according to age , sex , coexisting disease ( eg , heart failure , hypertension , chronic obstructive pulmonary disease ) , smoking , home medications ( eg , β-blocker , diuretic ) , physical examination findings ( eg , dyspnea , palpitations , peripheral edema ) , and adequacy of ED ventricular rate control . Primary outcome was occurrence of greater than or equal to 1 atrial fibrillation-related adverse outcome ( ED visits , rehospitalization , cardiovascular complications , death ) within 30 days . We identified a clinical ly relevant threshold and measured RED-AF 's performance in this prospect i ve cohort , assessing its calibration , discrimination , and diagnostic accuracy . RESULTS The study enrolled 497 patients between June 2010 and February 2013 . Of these , 120 ( 24 % ) had greater than or equal to 1 adverse event within 30 days . A RED-AF score of 87 was identified as an optimal threshold , result ing in sensitivity and specificity of 96 % ( 95 % confidence interval [ CI ] 91 % to 98 % ) and 19 % ( 95 % CI 15 % to 23 % ) , respectively . Positive and negative predictive values were 27 % ( 95 % CI 23 % to 32 % ) and 93 % ( 95 % CI 85 % to 97 % ) , respectively . The c statistic for RED-AF was 0.65 ( 95 % CI 0.59 to 0.71 ) . CONCLUSION In this separate validation cohort , RED-AF performed moderately well and similar to the original derivation cohort for identifying the risk of short-term atrial fibrillation-related adverse events in ED patients receiving a diagnosis of atrial fibrillation BACKGROUND Although hyperuricemia has been reported to be a risk factor of stroke , the relationship between hyperuricemia and stroke in patients with atrial fibrillation ( AF ) remains uncertain . The goal of the present study was to investigate whether hyperuricemia could potentially refine clinical risk stratification in AF . METHODS This study used the " National Health Insurance Research Data base " in Taiwan . A total of 7601 AF patients who did not receive antiplatelet agents or oral anticoagulants were identified as the study population . Hyperuricemia was defined as having at least one episode of gout attack necessitating long-term treatment with uric acid-lowering agents . The association between hyperuricemia and ischemic stroke was analyzed . RESULTS During the follow up of 3.0±2.7 years , 1116 patients ( 14.7 % ) experienced ischemic stroke with an annual rate of around 4.9 % . Hyperuricemia significantly predicts stroke , with a hazard ratio ( HR ) of 1.280 after adjusting for CHA2DS2-VASc score and other comorbidities . Among the 376 patients with a CHA2DS2VASc score of 0 , hyperuricemia can further stratify them into 2 groups with different stroke rates ( 7.1 % versus 1.3 % , p=0.020 ) . The adjusted HR of hyperuricemia in predicting ischemic stroke diminished from 7.491 for patients with a CHA2DS2-VASc score of 0 to 1.659 for those with a score of 3 , and became insignificant for patients with a score ≥4 . CONCLUSIONS Hyperuricemia was a significant risk factor of stroke which could potentially refine the clinical risk stratification in AF . It deserves a prospect i ve trial to investigate whether it would change the current strategy for stroke preventions using oral anticoagulants BACKGROUND An atrial fibrillation ( AF ) risk score for a non-Western general population has not been established . Methods and Results : A total of 6,898 participants ( 30 - 79 years old ) initially free of AF have been prospect ively followed for incident AF since 1989 . AF was diagnosed when AF or atrial flutter was present on ECG at a biannual health examination ; was indicated as a current illness ; or was in the medical records during follow-up . Cox proportional hazard ratios were analyzed after adjusting for cardiovascular risk factors at baseline . During the 95,180 person-years of follow-up , 311 incident AF events occurred . We developed a scoring system for each risk factor as follows : 0/-5 , 3/0 , 7/5 , and 9/9 points for men/women in their 30 s-40 s , 50 s , 60 s , and 70 s , respectively ; 2 points for systolic hypertension , overweight , excessive drinking , or coronary artery disease ; 1 point for current smoking ; -1 point for moderate non-high-density lipoprotein-cholesterol ; 4 points for arrhythmia ; and 8 , 6 , and 2 points for subjects with cardiac murmur in their 30 s-40 s , 50 s , and 60 s , respectively ( C-statistic 0.749 ; 95 % confidence interval , 0.724 - 0.774 ) . Individuals with score ≤2 , 10 - 11 , or ≥16 points had , respectively , ≤1 % , 9 % , and 27 % observed probability of developing AF in 10 years . CONCLUSIONS We developed a 10-year risk score for incident AF using traditional risk factors that are easily obtained in routine outpatient clinics/health examinations without ECG BACKGROUND AND PURPOSE By 1992 , several prospect i ve trials established the efficacy of anticoagulation ( AC ) and to some extent antiplatelet ( AP ) agents in the prevention of stroke in the setting of atrial fibrillation ( AF ) . The objective of this study was to determine whether practice patterns in AF stroke prophylaxis reflect the findings of clinical trials and whether stroke prophylaxis in AF differs between community hospitals and tertiary teaching hospitals . METHODS Retrospectively , 1250 hospital charts were review ed . After patients who had undergone recent surgery , received treatment for malignancy , or were not in chronic AF on discharge were eliminated , 651 remaining records were analyzed for the presence of 26 clinical factors influencing the selection of thromboembolism prophylaxis . Descriptive statistics and logistic regression were used to analyze the association between clinical and demographic factors and the decision to treat with AC , AP , or no specific antiembolic therapy . RESULTS Of the 651 patients in AF , 273 ( 42 % ) received noemboli prophylaxis while 219 ( 34 % ) were treated with AC ( warfarin ) , 146 ( 22 % ) were treated with AP , and 13 ( 2 % ) received both agents .  Patients discharged in AF from community hospitals were significantly less likely to be treated with either AC or AP agents than patients discharged from tertiary centers . A strong bias against thromboembolism prophylaxis with either AC or AP agents in AF existed with age over 45 years . Multivariate logistic regression indicated that the decision to treat was associated only with the presence of prosthetic valve , history of prior stroke , mitral disease , and absence of a recent gastrointestinal bleed or occult blood in stool . Even after adjustment for these factors , a significant bias against treatment with either AC or AP agents with advancing age and discharge from community hospitals remained . CONCLUSIONS Thromboembolism prophylaxis with either AC or AP agents is underutilized in the setting of AF . Furthermore , factors known to increase the risk of embolization in AF such as age , hypertension , diabetes , and heart disease were not associated with decisions to treat with either AP or AC agents . This study suggests that the use of clinical guidelines suggested by trials of thromboembolism prophylaxis in AF could reduce the incidence of stroke Background Oral anticoagulation prevents ischemic strokes in patients with atrial fibrillation ( AF ) . Early detection of AF and subsequent initiation of oral anticoagulation help to prevent strokes in AF patients . Implanted cardiac pacemakers and defibrillators allow seamless detection of atrial high rate episodes ( AHRE ) , but the best antithrombotic therapy in patients with AHRE is not known . Rationale Stroke risk is higher in pacemaker patients with AHRE than in those without , but the available data also show that stroke risk in patients with AHRE is lower than in patients with AF . Furthermore , only a minority of patients with AHRE will develop AF , many strokes occur without a temporal relation to AHRE , and AHRE can reflect other arrhythmias than AF or artifacts . An adequately powered controlled trial of oral anticoagulation in patients with AHRE is needed . Design The Non – vitamin K antagonist Oral anticoagulants in patients with Atrial High rate episodes ( NOAH – AFNET 6 ) trial tests whether oral anticoagulation with edoxaban is superior to prevent the primary efficacy outcome of stroke or cardiovascular death compared with aspirin or no antithrombotic therapy based on evidence ‐based indications . The primary safety outcome will be major bleeding . NOAH – AFNET 6 will r and omize 3,400 patients with AHRE , but without documented AF , aged ≥65 years with at least 1 other stroke risk factor , to oral anticoagulation therapy ( edoxaban ) or no anticoagulation . All patients will be followed until the end of this investigator‐driven , prospect i ve , parallel‐group , r and omized , event‐driven , double‐blind , multicenter phase IIIb trial . Patients will be censored when they develop AF and offered open‐label anticoagulation . The sponsor is the Atrial Fibrillation NETwork ( AFNET ) . The trial is supported by the DZHK ( German Centre for Cardiovascular Research ) , the BMBF ( German Ministry of Education and Research ) , and Daiichi Sankyo Europe . Conclusion NOAH – AFNET 6 will provide robust information on the effect of oral anticoagulation in patients with atrial high rate episodes detected by implanted devices . Graphical abstract Figure . No Caption available IMPORTANCE A substantial proportion of patients with atrial fibrillation ( AF ) die of noncardiovascular causes , and recent studies suggest a link between AF and cancer . OBJECTIVE To evaluate the associations between AF and cancer in a large , long-term prospect i ve cohort study . DESIGN , SETTING , AND PARTICIPANTS In this cohort study , a total of 34 691 women 45 years or older and free of AF , cardiovascular disease , and cancer at baseline were prospect ively followed up between 1993 and 2013 , for incident AF and malignant cancer within the Women 's Health Study , a r and omized clinical trial of aspirin and vitamin E for the prevention of cardiovascular disease and cancer . Cox proportional hazards models using time-up date d covariates were constructed to assess the association of new-onset AF with subsequent cancer and to adjust for potential confounders . Data analysis was performed from December 2014 to May 2015 . EXPOSURE New-onset AF . MAIN OUTCOMES AND MEASURES Incident malignant cancer confirmed by an end point committee . RESULTS During a median follow-up of 19.1 years of 34 691 study participants ( interquartile range [ IQR ] , 17.6 - 19.7 years ) , new-onset AF and malignant cancer were confirmed among 1467 ( 4.2 % ) and 5130 ( 14.8 % ) participants , respectively . Median age at baseline among participants with new-onset AF and new-onset cancer during follow-up was 58 years ( IQR , 52 - 64 years ) and 55 years ( IQR , 50 - 61 years ) , respectively . Atrial fibrillation was a significant risk factor for incident cancer in age-adjusted ( hazard ratio [ HR ] , 1.58 ; 95 % CI , 1.34 - 1.87 ; P < .001 ) and multivariable-adjusted ( HR , 1.48 ; 95 % CI , 1.25 - 1.75 ; P < .001 ) models . The relative risk of cancer was highest in the first 3 months after new-onset AF ( HR , 3.54 ; 95 % CI , 2.05 - 6.10 ; P < .001 ) but remained significant beyond 1 year after new-onset AF ( adjusted HR , 1.42 ; 95 % CI , 1.18 - 1.71 ; P < .001 ) , and a trend toward an increased cancer mortality was observed ( adjusted HR , 1.32 ; 95 % CI , 0.98 - 1.79 ; P = .07 ) . In contrast , among women with new-onset cancer , the relative risk of AF was increased only within the first 3 months ( HR , 4.67 ; 95 % CI , 2.85 - 7.64 ; P < .001 ) but not thereafter ( HR , 1.15 ; 95 % CI , 0.95 - 1.39 ; P = .15 ) . CONCLUSIONS AND RELEVANCE In this large , initially healthy cohort , women with new-onset AF had an elevated cancer risk beyond 1 year of AF diagnosis . Shared risk factors and /or common systemic disease processes might underlie this association Background — There is a paucity of international data on the various types of atrial fibrillation ( AF ) outside the highly selected population s from r and omized trials . This study aim ed to describe patient characteristics , risk factors , comorbidities , symptoms , management strategy , and control of different types of AF in real-life practice . Methods and Results — Real-life global survey evaluating patients with atrial fibrillation ( RealiseAF ) was a contemporary , large-scale , cross-sectional international survey of patients with AF who had ≥1 episode in the past 12 months . Investigators were r and omly selected to avoid bias . Among 9816 eligible patients from 831 sites in 26 countries , 2606 ( 26.5 % ) had paroxysmal , 2341 ( 23.8 % ) had persistent , and 4869 ( 49.6 % ) had permanent AF . As AF progressed from paroxysmal to persistent and permanent forms , the prevalence of comorbidities , such as heart failure ( 32.9 % , 44.3 % , and 55.6 % ) , coronary artery disease ( 30.0 % , 32.9 % , and 34.3 % ) , cerebrovascular disease ( 11.7 % , 10.8 % , and 17.6 % ) , and valvular disease ( 16.7 % , 21.2 % , and 35.8 % ) , increased , and the prevalence of lone AF decreased . Similarly , there was an increase in mean CHADS2 [ cardiac failure , hypertension , age , diabetes , stroke ( doubled ) ] score ( 1.7 , 1.8 , and 2.2 ) , and more than half of patients ( 51.0 % , 56.7 % , and 67.3 % ) qualified for oral anticoagulants . Almost 90 % of patients received ≥1 antiarrhythmic drug , but > 60 % had European Heart Rhythm Association symptom scores from II to IV . Furthermore , 40.7 % of persistent and 49.8 % of permanent AF patients were still in AF with a heart rate > 80 beats per minute . Conclusions — This survey disclosed high cardiovascular risks and an unmet need in daily practice for patients with any type of AF , especially those with the permanent form BACKGROUND Stroke and systemic thromboembolism are serious problems for patients with atrial fibrillation ( AF ) , but their incidence can be substantially reduced by appropriate anticoagulation . Bleeding is the major complication of anticoagulant treatment , and the relative risks for bleeding vs stroke must be considered when starting anticoagulation . METHODS The AFFIRM trial included patients with AF and at least one risk factor for stroke , r and omly assigning them to either a rate-control or rhythm-control strategy . All patients were initially treated with warfarin . The incidence of protocol -defined major and minor bleeding was documented during follow-up . Variables associated with bleeding were determined using a Cox proportional hazards model , using baseline and time-dependent covariates . RESULTS The 4060 patients in the AFFIRM trial were followed for an average of 3.5 years . Major bleeding occurred in 260 patients , an annual incidence of approximately 2 % per year , with no significant difference between the rate-control and rhythm-control groups . Increased age , heart failure , hepatic or renal disease , diabetes , first AF episode , warfarin use , and aspirin use were significantly associated with major bleeding . Minor bleeding was common in both treatment arms , with 738 patients reporting this problem in one or more visits . CONCLUSIONS Bleeding is a significant problem that complicates management of patients with AF . Risk factors for bleeding can be identified , and knowledge of these risk factors can be used to plan therapy Background Therapeutic decisions in atrial fibrillation ( AF ) are often influenced by assessment of bleeding risk . However , existing bleeding risk scores have limitations . Objectives We sought to develop and vali date a novel bleeding risk score using routinely available clinical information to predict major bleeding in a large , community-based AF population . Methods We analysed data from Outcomes Registry for Better Informed Treatment of Atrial Fibrillation ( ORBIT-AF ) , a prospect i ve registry that enrolled incident and prevalent AF patients at 176 US sites . Using Cox proportional hazards regression , we identified factors independently associated with major bleeding among patients taking oral anticoagulation ( OAC ) over a median follow-up of 2 years ( interquartile range = 1.6–2.5 ) . We also created a numerical bedside risk score that included the five most predictive risk factors weighted according to their strength of association with major bleeding . The predictive performance of the full model , the simple five-item score , and two existing risk scores ( hypertension , abnormal renal/liver function , stroke , bleeding history or predisposition , labile INR , elderly , drugs/alcohol concomitantly , HAS-BLED , and anticoagulation and risk factors in atrial fibrillation , ATRIA ) were then assessed in both the ORBIT-AF cohort and a separate clinical trial population , Rivaroxaban Once-daily oral direct factor Xa inhibition compared with vitamin K antagonism for prevention of stroke and embolism trial in atrial fibrillation ( ROCKET-AF ) . Results Among 7411 ORBIT-AF patients taking OAC , the rate of major bleeding was 4.0/100 person-years . The full continuous model ( 12 variables ) and five-factor ORBIT risk score ( older age [ 75 + years ] , reduced haemoglobin/haematocrit/history of anaemia , bleeding history , insufficient kidney function , and treatment with antiplatelet ) both had good ability to identify those who bled vs. not ( C-index 0.69 and 0.67 , respectively ) . These scores both had similar discrimination , but markedly better calibration when compared with the HAS-BLED and ATRIA scores in an external validation population from the ROCKET-AF trial . Conclusions The five-element ORBIT bleeding risk score had better ability to predict major bleeding in AF patients when compared with HAS-BLED and ATRIA risk scores . The ORBIT risk score can provide a simple , easily remembered tool to support clinical decision making Background The optimal antithrombotic treatment after percutaneous coronary intervention ( PCI ) with stenting in patients with atrial fibrillation ( AF ) is unknown . In the ENGAGE AF‐TIMI 48 trial , edoxaban was noninferior to a vitamin K antagonist ( VKA ) with respect to the prevention of stroke or systemic embolism and was associated with significantly lower rates of bleeding and cardiovascular death in patients with nonvalvular AF . The effects of edoxaban in combination with single‐ or dual‐antiplatelet therapy in the setting of PCI are unexplored . Design The ENTRUST‐AF PCI trial is a multinational , multicenter , r and omized , open‐label phase 3b trial with blinded end point evaluation involving 1,500 patients on oral anticoagulation for AF . Patients are r and omized between 4 hours and 5 days after successful PCI to either an edoxaban‐based strategy ( experimental arm ; 60 mg [ or 30 mg according to dose reduction criteria ] once daily plus a P2Y12 antagonist [ default clopidogrel , 75 mg once daily ] for 12 months ) or a VKA‐based strategy ( control arm ; VKA plus a P2Y12 antagonist [ as above ] plus acetylsalicylic acid [ 100 mg once daily ] for 30 days to 12 months ) . The primary safety end point is the incidence of International Society on Thrombosis and Haemostasis – defined major or clinical ly relevant nonmajor bleeding . The main efficacy end point is the composite of cardiovascular death , stroke , systemic embolic events , spontaneous myocardial infa rct ion , and definite stent thrombosis . Summary The ENTRUST‐AF PCI trial tests the hypothesis that an edoxaban‐based antithrombotic strategy reduces the risk of bleeding complications after PCI compared with VKA plus conventional dual‐antiplatelet therapy in patients with AF in need of oral anticoagulation . The relative risk of ischemic events between groups will be compared OBJECTIVES Despite all the advances in cardiac surgery , atrial fibrillation ( AF ) remains a common postoperative complication with unclear predisposing factors . Postoperative AF is often a short-lived and a self-limiting condition , but can result in debilitating and even lethal consequences . The aim of this study is to assess the effect of AF on patients postcardiac surgery . METHODS In this retrospective study , we prospect ively review ed patient data for our institution for a 10-year period ; a total of 17,379 patients with preoperative sinus rhythm ( SR ) who underwent cardiac surgery were included , of which 4984 ( 28.7 % ) had developed postoperative AF for any length of time . After propensity matching for the preoperative characteristics between the two groups ; the group with AF and the group who remained in SR , postoperative complications , in-hospital mortality , mid-term survival rate ( five years ) , and long-term survival rate ( 10 years ) were compared . RESULTS Before and after adjusting for the preoperative characteristics and type of the operation , postoperative complications , such as renal failure , surgical wound infection , stroke and myocardial infa rct ion were significantly higher in the AF group compared to the SR group ( P < 0.001 ) . Inotropic support , use of intra-aortic balloon pump , and ventilation time were also considerably higher in the AF patients ( P < 0.001 ) . In-hospital mortality was also higher in the AF group . Likewise , 30-day , mid-term and long-term mortality rates were found to be considerably higher in the AF group . CONCLUSIONS Despite all the modern anti-arrhythmic drugs , the incidence of AF remains unchanged . Patients who develop AF postcardiac surgery show a significantly worse outcome compared to those without AF . This study also highlights the importance of anticoagulation in AF to prevent the devastating consequences as a result of a cerebral stroke . We believe that not only immediate treatment of AF postoperatively should be implemented , but also measures should be taken to identify the risk factors of AF and to prevent AF postcardiac surgery BACKGROUND The risk of acute myocardial infa rct ion ( AMI ) in patients with atrial fibrillation ( AF ) with a CHA2DS2-VASc score of 0 ( for men ) or 1 ( for women ) has not been previously investigated . OBJECTIVE The objective of the present study was to compare the risk of AMI in AF and non-AF subjects with a low ( 0 or 1 ) CHA2DS2-VASc score . METHODS By using the National Health Insurance Research Data base in Taiwan , we identified 7254 men with AF ( with a CHA2DS2-VASc score of 0 ) and 4860 women with AF ( with a CHA2DS2-VASc score of 1 ) . For each study patient , 1 age- , sex- , and CHA2DS2-VASc score-matched subject  without AF was r and omly selected to constitute the control group ( n = 12,114 ) . The clinical end point was the occurrence of AMI . RESULTS During a mean follow-up period of 5.7 ± 3.6 years , 258 patients ( 1.1 % ) suffered an AMI , with an annual incidence of 0.29 % and 0.10 % for patients with and without AF . AF was an independent risk factor of AMI , with an adjusted hazard ratio ( HR ) of 2.93 ( 95 % confidence interval 2.21 - 3.87 ; P < .001 ) . The risk of AMI was higher in men with AF than in women with AF , with a hazard ratio of 2.24 ( 95 % confidence interval 1.61 - 3.11 ; P < .001 ) after adjustment for age and other comorbidities . CONCLUSION In patients with a CHA2DS2-VASc score of 0 or 1 , AF was an independent risk factor of AMI . The risk of AMI was higher in men with AF than in women with AF . Cardiovascular risk prevention should be performed as part of the holistic management of AF to minimize the risks of AMI associated with AF Background Atrial fibrillation ( AF ) has been recognised as an important independent risk factor for thromboembolic disease , particularly stroke for which it provides a five-fold increase in risk . This study aim ed to determine the baseline prevalence and the incidence of AF based on a variety of screening strategies and in doing so to evaluate the incremental cost-effectiveness of different screening strategies , including targeted or whole population screening , compared with routine clinical practice , for detection of AF in people aged 65 and over . The value of clinical assessment and echocardiography as additional methods of risk stratification for thromboembolic disease in patients with AF were also evaluated . Methods The study design was a multi-centre r and omised controlled trial with a study population of patients aged 65 and over from 50 General Practice s in the West Midl and s. These purpose fully selected general practice s were r and omly allocated to 25 intervention practice s and 25 control practice s. GPs and practice nurses within the intervention practice s received education on the importance of AF detection and ECG interpretation . Patients in the intervention practice s were r and omly allocated to systematic ( n = 5000 ) or opportunistic screening ( n = 5000 ) . Prospect i ve identification of pre-existing risk factors for AF within the screened population enabled comparison between high risk targeted screening and total population screening . AF detection rates in systematic ally screened and opportunistically screened population s in the intervention practice s were compared to AF detection rate in 5,000 patients in the control practice The object of this article was to estimate the incidence rate of chronic atrial fibrillation ( AF )  in a general practice setting , to identify factors predisposing to its occurrence , and to describe treatment patterns in the year following the diagnosis . The method used was a population -based cohort study using the General Practice Research Data base ( GPRD ) in the UK . We identified patients aged 40 - 89 years with a first ever recorded diagnosis of AF . The diagnosis was vali date d through a question naire sent to the general practitioners . A nested case-control analysis was performed to assess risk factors for AF using 1,035 confirmed incident cases of chronic AF and a r and om sample of 5,000 controls from the original source population . The incidence rate of chronic AF was 1.7 per 1,000 person-years , and increased markedly with age . The age adjusted rate ratio among males was 1.4 ( 95 % CI 1.2 - 1.6 ) . The major risk factors were age , high BMI , excessive alcohol consumption , and prior cardiovascular comorbidity , in particular , valvular heart disease and heart failure . Digoxin was used in close to 70 % of the patients , and close to 15 % did not receive any antiarrhythmic treatment . Close to 40 % did not receive either warfarin or aspirin in the 3 months period after the diagnosis . Among the potential c and i date s for anticoagulation only 22 % of those aged 70 years or older were prescribed warfarin in comparison to 49 % among patients aged 40 - 69 years . Chronic AF is a disease of the elderly , with women presenting a lower incidence rate than men specially in young age . Age , weight , excessive alcohol consumption , and cardiovascular morbidity were the main independent risk factors for AF . Less than half of patients with chronic AF and no contraindications for anticoagulation received warfarin within the first trimester after the diagnosis
A systematic evaluation of the available evidence suggests similarities as well as important differences in the risk factors for incidence of AF as compared with other cardiovascular diseases , which has implication s for the primary prevention strategies for atrial fibrillation
Established primary prevention strategies of cardiovascular diseases are based on underst and ing of risk factors , but whether the same risk factors are associated with  atrial fibrillation ( AF )  remains unclear .