Prognostic impact of vascular disease in patients with atrial fibrillation: Insights from The Loire Valley Atrial Fibrillation Project

Abstract

Type of funding sources: None. Vascular disease which comprises peripheral artery disease, significant coronary artery disease and aortic disease is associated with both an increased risk of atrial fibrillation (AF) and ischaemic stroke in AF patients. We investigated the effect of vascular disease on the prognosis of AF patients. In this retrospective analysis, all patients with AF were identified and classified into 2 groups depending on the presence of vascular disease. 3 patients were excluded due to missing data. Primary outcome was a composite of death, stroke and thromboembolic events. Secondary outcomes included all-cause mortality, stroke or systemic embolism (SSE), ischaemic stroke, haemorrhagic stroke and major bleeding. A total of 8962 patients were included; 3021 with vascular disease and 5941 without vascular disease and followed up over a mean period of 929±1082 days. On the univariate analysis, patients with vascular disease were at a higher risk of all-cause mortality hazard ratio (HR) 1.728 ((confidence interval (CI)1.549-1.928), SSE HR HR 1.477 (CI 1.274-1.714), ischaemic stroke HR 1.441 (CI 1.202-1.727), major bleeding HR 1.488 (CI 1.292-1.713) and a composite of death and SSE HR 1.643 (CI 1.489-1.812), compared to patients without vascular disease. On a multivariate analysis, after adjusting for components of the CHA2DS2VASc score, oral anticoagulation (warfarin) use and antiplatelet use, the increased risk of all-cause mortality HR 1.460 (CI 1.285-1.658), SSE HR 1.226 (CI 1.030-1.458) and major bleeding HR 1.186 (CI 1.005-1.400) remained statistically significant, but the risk of ischaemic stroke was no longer significant, HR 1.187 (CI 0.960-1.469). Compared to those without vascular disease, patients with vascular disease were at a lower risk of haemorrhagic strokes but this was not significant. AF patients with vascular disease are at a higher risk of all-cause mortality, SSE and major bleeding compared to patients without vascular disease, indicating that patients with this combination require careful and holistic management in terms of risk factor control and treatment. Additional research is required to further characterise the relationship between the two.