TY - JOUR
T1 - Prevalence, Characteristics, and Outcomes of Valvular Heart Disease in Patients With Atrial Fibrillation
T2 - Insights From the ORBIT-AF (Outcomes Registry for Better Informed Treatment for Atrial Fibrillation)
AU - Thomas, Kevin L.
AU - Jackson, Larry R.
AU - Shrader, Peter
AU - Ansell, Jack
AU - Fonarow, Gregg C.
AU - Gersh, Bernard
AU - Kowey, Peter R.
AU - Mahaffey, Kenneth W.
AU - Singer, Daniel E.
AU - Thomas, Laine
AU - Piccini, Jonathan P.
AU - Peterson, Eric D.
N1 - Funding Information:
Thomas reports being a consultant for Pfizer, Bristol Myers Squibb, and Janssen Pharmaceuticals; and receiving research support from the Patient Centered Research Outcomes Research Institute. Ansell reports consulting activities with Bristol Myers Squibb, Pfizer, Janssen, Daiichi Sankyo, Boehringer Ingelheim, Peroshpere Equity, and Perosphere, Inc. Fonarow reports modest consultant/advisory board support from Janssen Pharmaceuticals. Gersh reports being a member of a Data Safety Monitoring Board for Mount Sinai St Lukes, Boston Scientific Corporation, Teva Pharmaceutical Industries, St Jude Medical, Janssen Research and Development, Baxter Healthcare Corporation, and Cardiovascular Research Foundation; doing general consulting for Janssen Scientific Affairs, Cipla Limited, and Armetheon Inc; and being on an advisory board for Medtronic. Kowey reports serving as a consultant to or being on the advisory board of Johnson & Johnson, Daiichi Sankyo, Boehringer Ingelheim, and Bristol Myers Squibb. Financial disclosures for Mahaffey before August 1, 2013, can be viewed at https://www.dcri.org/ab out-us/conflict-of-interest/Mahaffey-COI_2011-2013.pdf; disclosures after August 1, 2013, can be viewed at http:// med.stanford.edu/profiles/kenneth-mahaffey. Singer reports research grants from Boerhinger Ingelheim and Bristol Myers Squibb; being a consultant/advisory board member for Boerhinger Ingelheim, Bristol Myers Squibb, Merck, Johnson & Johnson, Pfizer, and Medtronic; and being an executive committee member of the ROCKET AF (Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared With Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation) trial of rivaroxaban in atrial fibrillation. L. Thomas reports research with Novartis, Boston Scientific, Gilead, and Janssen Scientific. Piccini reports receiving research grants or research support from Johnson & Johnson/Janssen Pharmaceuticals, Boston Scientific Corp, ARCA Biopharma, Gilead, Res Med, and St Jude; and consultant/ advisory board fees from Glaxo Smith-Kline, Medtronic Inc, Johnson & Johnson/Janssen Pharmaceuticals, Pfizer, and Spectranetics. Peterson reports consulting and participation in research with Janssen Pharmaceuticals and Bayer Co.
Publisher Copyright:
© 2022 by the authors.
PY - 2017/12/2
Y1 - 2017/12/2
N2 - Background-—The presence of valvular heart disease (VHD) may affect the risk of stroke and mortality in patients with atrial fibrillation (AF). Community-based estimates of prevalence and outcomes of specific forms of VHD in patients with AF are lacking. Methods and Results-—We examined the prevalence of VHD, anticoagulation use, mortality, stroke/transient ischemic attack, and bleeding among a community cohort of patients with AF. Significant VHD was defined as follows: (1) moderate/severe mitral stenosis or mechanical valve; (2) bioprosthetic valve, surgical repair, or balloon valvuloplasty; and (3) moderate/severe aortic regurgitation or stenosis, mitral regurgitation, or tricuspid regurgitation. Proportional hazards models were performed to test the association between VHD groups and outcomes. Among 9748 patients with AF, 2705 (27.7%) had significant VHD. Anticoagulation use was highest among patients with mitral stenosis/mechanical valve (91.8%). Compared with individuals with no significant VHD, individuals with aortic regurgitation/aortic stenosis, mitral regurgitation, or tricuspid regurgitation (hazard ratio, 1.23; 95% confidence interval, 1.07–1.42) had the highest risk of death. There were no differences in stroke or transient ischemic attack and major bleeding among individuals with and without significant VHD. Patients with AF and aortic stenosis had the highest risk of death (hazard ratio, 1.32; 95% confidence interval, 1.08–1.62). Conclusions-—Significant VHD is common among patients with AF in community practice. In a community cohort of patients with AF and CHA2DS2-VASc score ≥2, most were anticoagulated. Individuals with AF and moderate-to-severe biological VHD have more comorbidities and a higher mortality risk; however, stroke and major bleeding are similar among those with and without significant VHD. (J Am Heart Assoc. 2017;6:e006475. DOI: 10.1161/JAHA.117.006475.).
AB - Background-—The presence of valvular heart disease (VHD) may affect the risk of stroke and mortality in patients with atrial fibrillation (AF). Community-based estimates of prevalence and outcomes of specific forms of VHD in patients with AF are lacking. Methods and Results-—We examined the prevalence of VHD, anticoagulation use, mortality, stroke/transient ischemic attack, and bleeding among a community cohort of patients with AF. Significant VHD was defined as follows: (1) moderate/severe mitral stenosis or mechanical valve; (2) bioprosthetic valve, surgical repair, or balloon valvuloplasty; and (3) moderate/severe aortic regurgitation or stenosis, mitral regurgitation, or tricuspid regurgitation. Proportional hazards models were performed to test the association between VHD groups and outcomes. Among 9748 patients with AF, 2705 (27.7%) had significant VHD. Anticoagulation use was highest among patients with mitral stenosis/mechanical valve (91.8%). Compared with individuals with no significant VHD, individuals with aortic regurgitation/aortic stenosis, mitral regurgitation, or tricuspid regurgitation (hazard ratio, 1.23; 95% confidence interval, 1.07–1.42) had the highest risk of death. There were no differences in stroke or transient ischemic attack and major bleeding among individuals with and without significant VHD. Patients with AF and aortic stenosis had the highest risk of death (hazard ratio, 1.32; 95% confidence interval, 1.08–1.62). Conclusions-—Significant VHD is common among patients with AF in community practice. In a community cohort of patients with AF and CHA2DS2-VASc score ≥2, most were anticoagulated. Individuals with AF and moderate-to-severe biological VHD have more comorbidities and a higher mortality risk; however, stroke and major bleeding are similar among those with and without significant VHD. (J Am Heart Assoc. 2017;6:e006475. DOI: 10.1161/JAHA.117.006475.).
KW - Anticoagulant
KW - atrial fibrillation
KW - mortality
KW - stroke
KW - valve
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UR - http://www.scopus.com/inward/citedby.url?scp=85061992662&partnerID=8YFLogxK
U2 - 10.1161/JAHA.117.006475
DO - 10.1161/JAHA.117.006475
M3 - Article
C2 - 29273635
AN - SCOPUS:85061992662
SN - 2047-9980
VL - 6
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 12
M1 - e006475
ER -