Asymptomatic atrial fibrillation poses challenges for cardiac care

Risks are higher for asymptomatic paroxysmal AF patients than symptomatic paroxysmal AF patients, according to a new study in the journal CHEST®


Glenview, IL, January 17, 2018

Atrial fibrillation (AF) can often be asymptomatic, leading to difficulties in diagnosis and untreated risks for morbidity and mortality. The occurrence of paroxysmal AF (PAF), in which the fibrillation event is intermittent, resolves without medical intervention and lasts for less than seven days, adds another layer of diagnostic complication. In a study published in the journal CHEST®, researchers found that asymptomatic PAF patients are more likely to be older, male, and have more comorbidities and a higher risk of stroke than symptomatic patients. In an analysis of a sustained AF (SAF) group, the prevalence of major comorbidities and stroke risk were comparable in both asymptomatic and symptomatic patients.

According to lead author Masahiro Esato, MD, PhD, of the Department of Arrhythmia, Ijinkai Takeda General Hospital, Japan, “Although asymptomatic AF is common in daily ‘real-world’ clinical practice, the relationship between patient characteristics/clinical outcomes and symptom presentation has not been consistent across studies and therefore remains controversial. Our study was designed to shed light on this relationship.” He notes that no detailed recommendation for asymptomatic AF management has been described, even in the latest AF guidelines.

Using data from the Fushimi AF Registry, a community-based prospective survey of patients with AF who visited the participating medical institutions in Fushimi-ku, Japan, researchers investigated the clinical characteristics and outcomes of asymptomatic and symptomatic patients with PAF (1,837 patients) and SAF (1,912 patients). In the PAF group, 689 were asymptomatic; while in the SAF group, 1,282 were asymptomatic. Median follow-up was 1,099 days.

Baseline clinical characteristics of all patients were collected, including a history of stroke or systemic embolism, heart failure, diabetes mellitus, heart failure, hypertension, and other medical conditions, as well as assessment stroke risk factor scores for patients with nonrheumatic atrial fibrillation. Use of oral anticoagulants and other drug therapies was also tracked.

The clinical characteristics and outcomes of asymptomatic AF patients were different between the PAF and SAF groups. During the follow-up period, the investigators found that all-cause mortality was higher in asymptomatic than symptomatic patients but only in the PAF group. This study also found poorer clinical outcomes in asymptomatic patients compared with the clinical outcomes of symptomatic patients in the PAF group but not in the SAF group.

All-cause mortality of asymptomatic versus symptomatic patients in PAF and SAF. Kaplan-Meier curves for the incidences of all-cause death between asymptomatic and symptomatic patients with PAF (left) and SAF (right). HR = hazard ratio.

Although this study had several limitations, including its observational nature, data only drawn from an urban district in Japan, and other factors, the investigators maintain that useful lessons may be learned. “Despite these limitations, our study highlights the differences in the clinical profile and outcomes between asymptomatic and symptomatic patients in both the PAF and SAF groups,” commented lead investigator Masaharu Akao, MD, PhD, of the Department of Cardiology, National Hospital Organization, Kyoto Medical Center, Kyoto, Japan. “The present data also showed that asymptomatic patients with PAF may not receive adequate treatment, and thus early detection and more intensive medical management of these patients are recommended.”

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Notes for editors
The article is “Clinical Impact of Asymptomatic Presentation Status in Patients With Paroxysmal and Sustained Atrial Fibrillation: The Fushimi AF Registry,” by Masahiro Esato, MD, PhD; Yeung-Hwa Chun, MD, PhD; Yoshimori An, MD; Hisashi Ogawa, MD; Hiromichi Wada, MD, PhD; Koji Hasegawa, MD, PhD; Hikari Tsuji, MD, PhD; Mitsuru Abe, MD, PhD; Gregory Y.H. Lip, MD; Masaharu Akao, MD, PhD (http://dx.doi.org/10.1016/j.chest.2017.08.004). It appears in the journal CHEST, volume 152, issue 6 (December 2017) published by Elsevier. It is openly available at http://journal.chestnet.org/article/S0012-3692(17)31397-1/fulltext.

Full text of this article and interviews with the authors are available to credentialed journalists upon request; contact Andrea Camino, American College of Chest Physicians, at +1 224-521-9513 or acamino@chestnet.org.

About the journal CHEST®
The journal CHEST®, the official publication of the American College of Chest Physicians, features the best in peer-reviewed, cutting-edge original research in the multidisciplinary specialties of chest medicine: pulmonary, critical care and sleep medicine; thoracic surgery; cardiorespiratory interactions; and related disciplines. Published since 1935, it is home to the highly regarded clinical practice guidelines and consensus statements. Readers find the latest research posted in the Online First section each week and access series that provide insight into relevant clinical areas, such as Recent Advances in Chest Medicine; Topics in Practice Management; Pulmonary, Critical Care and Sleep Pearls; Ultrasound Corner; Chest Imaging and Pathology for Clinicians; and Contemporary Reviews. Point/Counterpoint Editorials and the CHEST Podcasts address controversial issues, fostering discussion among physicians. www.chestjournal.org

About American College of Chest Physicians (CHEST)
CHEST is the global leader in advancing best patient outcomes through innovative chest medicine education, clinical research and team-based care. Its mission is to champion the prevention, diagnosis and treatment of chest diseases through education, communication and research. CHEST serves as an essential connection to clinical knowledge and resources for its 19,000 members from around the world who provide patient care in pulmonary, critical care and sleep medicine. For more information, visit www.chestnet.org.

About Elsevier
Elsevier is a global information analytics business that helps institutions and professionals advance healthcare, open science, and improve performance for the benefit of humanity. Elsevier provides digital solutions and tools in the areas of strategic research management, R&D performance, clinical decision support, and professional education; including ScienceDirect, Scopus, SciVal, ClinicalKey and Sherpath. Elsevier publishes over 2,500 digitized journals, including The Lancet and Cell, more than 35,000 e-book titles and many iconic reference works, including Gray's Anatomy. Elsevier is part of RELX Group, a global provider of information and analytics for professionals and business customers across industries. www.elsevier.com

Media contact
Andrea Camino
American College of Chest Physicians (CHEST)
+1 224-521-9513
acamino@chestnet.org