Atrial fibrillation detected at screening is not a benign condition: outcomes in screen-detected versus clinically detected atrial fibrillation. Results from the Prevention of Renal and Vascular End-stage Disease (PREVEND) study
Aims It is unknown whether screen-detected atrial fibrillation (AF) carries cardiovascular risks similar to clinically detected AF. We aimed to compare clinical outcomes between individuals with screen-detected and clinically detected incident AF.Methods We studied 8265 participants (age 49 ± 13 yea...
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BMJ Publishing Group
2021-12-01
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| Series: | Open Heart |
| Online Access: | https://openheart.bmj.com/content/8/2/e001786.full |
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| author | Rudolf A de Boer Ron T Gansevoort Stephan J L Bakker Michiel Rienstra Isabelle C van Gelder Bastiaan Geelhoed Victor W Zwartkruis Navin Suthahar |
| author_facet | Rudolf A de Boer Ron T Gansevoort Stephan J L Bakker Michiel Rienstra Isabelle C van Gelder Bastiaan Geelhoed Victor W Zwartkruis Navin Suthahar |
| author_sort | Rudolf A de Boer |
| collection | DOAJ |
| description | Aims It is unknown whether screen-detected atrial fibrillation (AF) carries cardiovascular risks similar to clinically detected AF. We aimed to compare clinical outcomes between individuals with screen-detected and clinically detected incident AF.Methods We studied 8265 participants (age 49 ± 13 years, 50% women) without prevalent AF from the community-based Prevention of Renal and Vascular End-stage Disease (PREVEND) study. By design of the PREVEND study, 70% of participants had a urinary albumin concentration >10 mg/L. Participants underwent 12-lead ECG screening at baseline and every 3 years. AF was considered screen-detected when first diagnosed during a study visit and clinically detected when first diagnosed during a hospital visit. We analysed data from the baseline visit (1997–1998) up to the third follow-up visit (2008). We used Cox regression with screen-detected and clinically detected AF as time-varying covariates to study the association of screen-detected and clinically detected AF with all-cause mortality, incident heart failure (HF) and vascular events.Results During a follow-up of 9.8 ± 2.3 years, 265 participants (3.2%) developed incident AF, of whom 60 (23%) had screen-detected AF. The majority of baseline characteristics were comparable between individuals with screen-detected and clinically detected AF. Unadjusted, both screen-detected and clinically detected AF were strongly associated with mortality, incident HF, and vascular events. After multivariable adjustment, screen-detected and clinically detected AF remained significantly associated with mortality (HR 2.21 (95% CI 1.09 to 4.47) vs 2.95 (2.18 to 4.00), p for difference=0.447) and incident HF (4.90 (2.28 to 10.57) vs 3.98 (2.49 to 6.34), p for difference=0.635). After adjustment, screen-detected AF was not significantly associated with vascular events, whereas clinically detected AF was (1.12 (0.46 to 2.71) vs 1.92 (1.21 to 3.06), p for difference=0.283).Conclusion Screen-detected incident AF was associated with an increased risk of adverse outcomes, especially all-cause mortality and incident HF. The risk of outcomes was not significantly different between screen-detected AF and clinically detected AF. |
| format | Article |
| id | doaj-art-e4f10c02dbff4b4ca26f383cf591278d |
| institution | OA Journals |
| issn | 2053-3624 |
| language | English |
| publishDate | 2021-12-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | Open Heart |
| spelling | doaj-art-e4f10c02dbff4b4ca26f383cf591278d2025-08-20T02:13:48ZengBMJ Publishing GroupOpen Heart2053-36242021-12-018210.1136/openhrt-2021-001786Atrial fibrillation detected at screening is not a benign condition: outcomes in screen-detected versus clinically detected atrial fibrillation. Results from the Prevention of Renal and Vascular End-stage Disease (PREVEND) studyRudolf A de Boer0Ron T Gansevoort1Stephan J L Bakker2Michiel Rienstra3Isabelle C van Gelder4Bastiaan Geelhoed5Victor W Zwartkruis6Navin Suthahar7Department of Cardiology, University Medical Centre Groningen, Groningen, The NetherlandsDepartment of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands2 University Medical Centre, Groningen, NetherlandsDepartment of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The NetherlandsDepartment of Cardiology, University Medical Centre Groningen, Groningen, The NetherlandsDepartment of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The NetherlandsDepartment of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The NetherlandsDepartment of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The NetherlandsAims It is unknown whether screen-detected atrial fibrillation (AF) carries cardiovascular risks similar to clinically detected AF. We aimed to compare clinical outcomes between individuals with screen-detected and clinically detected incident AF.Methods We studied 8265 participants (age 49 ± 13 years, 50% women) without prevalent AF from the community-based Prevention of Renal and Vascular End-stage Disease (PREVEND) study. By design of the PREVEND study, 70% of participants had a urinary albumin concentration >10 mg/L. Participants underwent 12-lead ECG screening at baseline and every 3 years. AF was considered screen-detected when first diagnosed during a study visit and clinically detected when first diagnosed during a hospital visit. We analysed data from the baseline visit (1997–1998) up to the third follow-up visit (2008). We used Cox regression with screen-detected and clinically detected AF as time-varying covariates to study the association of screen-detected and clinically detected AF with all-cause mortality, incident heart failure (HF) and vascular events.Results During a follow-up of 9.8 ± 2.3 years, 265 participants (3.2%) developed incident AF, of whom 60 (23%) had screen-detected AF. The majority of baseline characteristics were comparable between individuals with screen-detected and clinically detected AF. Unadjusted, both screen-detected and clinically detected AF were strongly associated with mortality, incident HF, and vascular events. After multivariable adjustment, screen-detected and clinically detected AF remained significantly associated with mortality (HR 2.21 (95% CI 1.09 to 4.47) vs 2.95 (2.18 to 4.00), p for difference=0.447) and incident HF (4.90 (2.28 to 10.57) vs 3.98 (2.49 to 6.34), p for difference=0.635). After adjustment, screen-detected AF was not significantly associated with vascular events, whereas clinically detected AF was (1.12 (0.46 to 2.71) vs 1.92 (1.21 to 3.06), p for difference=0.283).Conclusion Screen-detected incident AF was associated with an increased risk of adverse outcomes, especially all-cause mortality and incident HF. The risk of outcomes was not significantly different between screen-detected AF and clinically detected AF.https://openheart.bmj.com/content/8/2/e001786.full |
| spellingShingle | Rudolf A de Boer Ron T Gansevoort Stephan J L Bakker Michiel Rienstra Isabelle C van Gelder Bastiaan Geelhoed Victor W Zwartkruis Navin Suthahar Atrial fibrillation detected at screening is not a benign condition: outcomes in screen-detected versus clinically detected atrial fibrillation. Results from the Prevention of Renal and Vascular End-stage Disease (PREVEND) study Open Heart |
| title | Atrial fibrillation detected at screening is not a benign condition: outcomes in screen-detected versus clinically detected atrial fibrillation. Results from the Prevention of Renal and Vascular End-stage Disease (PREVEND) study |
| title_full | Atrial fibrillation detected at screening is not a benign condition: outcomes in screen-detected versus clinically detected atrial fibrillation. Results from the Prevention of Renal and Vascular End-stage Disease (PREVEND) study |
| title_fullStr | Atrial fibrillation detected at screening is not a benign condition: outcomes in screen-detected versus clinically detected atrial fibrillation. Results from the Prevention of Renal and Vascular End-stage Disease (PREVEND) study |
| title_full_unstemmed | Atrial fibrillation detected at screening is not a benign condition: outcomes in screen-detected versus clinically detected atrial fibrillation. Results from the Prevention of Renal and Vascular End-stage Disease (PREVEND) study |
| title_short | Atrial fibrillation detected at screening is not a benign condition: outcomes in screen-detected versus clinically detected atrial fibrillation. Results from the Prevention of Renal and Vascular End-stage Disease (PREVEND) study |
| title_sort | atrial fibrillation detected at screening is not a benign condition outcomes in screen detected versus clinically detected atrial fibrillation results from the prevention of renal and vascular end stage disease prevend study |
| url | https://openheart.bmj.com/content/8/2/e001786.full |
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