1. History Of Atrial Fibrillation In A First-Degree Relative
And Risk Of Cardiovascular Events
Daniele Pastori(1), Pasquale Pignatelli(1), Tommasa Vicario(1), Danilo Menichelli(1), Francesco Perticone(2), Angela Sciacqua(2), Francesco Violi(1) and the Atherosclerosis in Atrial Fibrillation (ATHERO-AF) Study Group*
(1) I Clinica Medica, Atherothrombosis Center, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome; (2) Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Italy
Background
Materials & Methods
Results
Table 1. Baseline characteristics of patients
Variables
Overall
Familiarity for AF
p value
(n=1289)
No (n=1030)
Yes (n=259)
Age (years)
73,2±9,1
73,7±8,9
71,1±9,6
<0.001
Women (%)
44,0
43,2
47,3
0,262
Arterial Hypertension (%)
87,8
87,5
89,1
0,523
Diabetes (%)
21,8
21,6
22,6
0,736
Heart failure (%)
15,6
15,4
16,5
0,699
Previous cerebrovascular events (%)
13,6
14,0
12,2
0,476
Previous cardiovascular events (%)
18,5
18,1
20,4
0,417
Prospective multicenter cohort study including 1309 anticoagulated AF patients. Familial AF was defined as the presence of known history of AF in a first-degree family member: parents, sibling, or children. AF patients were recruited from the Atherothrombosis Centre of I Clinica Medica of “Sapienza” University of Rome, from the Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Italy. Primary outcome was a composite of CVEs including fatal/non-fatal ischemic stroke and myocardial infarction (MI), arterial revascularization (both cardiac and peripheral) and cardiovascular (CV) death. Diagnosis of MI was made according to the definition proposed by the Joint ESC/ACCF/AHA/WHF Task Force. The occurrence of ischemic stroke was determined on clinical manifestations and confirmed by radiological findings. If a patient died within 4 weeks of MI or ischemic stroke, these events were recorded as fatal MI or ischemic stroke, respectively. Death was classified as CV unless an unequivocal non-CV cause of death was identified. CV death included sudden death; progressive congestive heart failure; procedure related death. Data on CV events were prospectively collected during follow-up, and only the first CV event was used for the analysis.
Mean age was 73.2±9.1 years and 44% were women; 20 patients were excluded for missing informations about family history. Familial AF was present in 259 (20.1%) patients; in 14,3% of familial cases, more than 1 relative had a history of AF. Patients with familial AF had an earlier onset of AF compared to non-familial (Figure 1, p<0.001). Moreover, AF patients with multiple familial AF showed a further early onset of AF compared to those with single familial AF (60.7±12.3 vs. 66.2±10.1, respectively p=0.003). Baseline characteristics of patients included in the study are reported in Table 1. The presence of familial AF was associated with an increased rate of CVEs (n=117) at a median follow-up of 24 months (Log-rank test, p=0.024, Figure 2).
Familial atrial fibrillation (AF) has been shown to be a risk factor for new-onset AF. The association between the presence of familial AF and cardiovascular events (CVEs) in a large cohort of elderly patients with AF has never been investigated.
Objective
To investigate the relationship between familial AF and CVEs in a prospective cohort of AF patients
At Cox multivariable regression analysis, familial AF (HR %CI , p=0.001), male gender (HR %CI , p=0.017), age (HR 1.08, 95%CI ,, p<0.001), previous stroke/TIA (HR %CI , p=0.022), previous myocardial infarction (HR 1.58, 95%CI , p=0.028), heart failure (HR 1.66, 95%CI , p=0.022), after adjustment for hypertension and diabetes.
Figure 2.
Conclusions
Our study show a high prevalence of familial AF, which confers an increased risk for CVEs. These results claim for the need of recognizing patients with familial AF, as to plan appropriate and cost-effective prevention strategies.
* ATHERO-AF Study Group Members: Mirella Saliola, Fabiana Albanese, Francesco Cribari, Francesco Del Sole, Alberto Paladino, Roberto Carnevale, Simona Bartimoccia, Cristina Nocella, Marta Novo
Contact mail: Disclosures: none.