Understanding the incidence of atrial fibrillation and stroke in hypertrophic cardiomyopathy patients: insights from Danish nationwide registries

Christopher R Zörner, Anne-Marie Schjerning, Morten Kvistholm Jensen, Alex Hørby Christensen, Jacob Tfelt-Hansen, Jacob Tønnesen, Lise Da Riis-Vestergaard, Charlotte Middelfart, Peter Vibe Rasmussen, Gunnar Gislason, Morten Lock Hansen

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Abstract

AIMS: The treatment of atrial fibrillation (AF) in hypertrophic cardiomyopathy (HCM) can be challenging since AF aggravates symptoms and increases the risk of stroke. Which factors contribute to the development of AF and stroke in HCM remains unknown. The aim of this study was to determine the incidence of AF and stroke in HCM patients and identify the risk factors.

METHODS AND RESULTS: Using Danish national registries, all HCM patients from 2005 to 2018 were included. The association between HCM, incident AF, and stroke was investigated using multivariable Cox proportional hazards analysis. Cumulative incidences were calculated using the Aalen-Johansen estimator. Among the 3367 patients without prevalent AF, 24% reached the endpoint of incident AF with death as a competing risk. Median follow-up time was 4 years. Atrial fibrillation incidence was equal between sexes and increased for patients with ischaemic heart disease [IHD; hazard ratio (HR) 1.33, 95% confidence interval (CI) 1.08-1.63], hypertension (HT) (HR 1.36, 95% CI 1.14-1.67), and obstructive HCM (HR 1.27, 95% CI 1.05-1.52). Seven per cent developed stroke, with no difference detected stratifying for the presence of AF. Sub-analysis revealed that when AF was treated with oral anticoagulants (OACs), stroke was less likely (HR 0.4, 95% CI 0.18-0.86, P = 0.02). However, 34% of patients were not receiving adequate anticoagulation following AF diagnosis.

CONCLUSION: Obstructive HCM, HT, and IHD were associated with increased risk of AF. Prevalent AF alone was not predictive of stroke; however, AF patients treated with OAC were significantly less likely to develop stroke, suggesting that this development is driven by the protective effect of OAC. Despite this, 34% of patients did not receive OAC.

Original languageEnglish
Article numbereuae177
JournalEuropace
Volume26
Issue number7
Number of pages9
ISSN1099-5129
DOIs
Publication statusPublished - 2024

Bibliographical note

© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.

Keywords

  • Humans
  • Atrial Fibrillation/epidemiology
  • Cardiomyopathy, Hypertrophic/epidemiology
  • Male
  • Female
  • Denmark/epidemiology
  • Registries
  • Incidence
  • Middle Aged
  • Stroke/epidemiology
  • Risk Factors
  • Aged
  • Adult
  • Risk Assessment

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