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Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Associate Professor Johan Engdahl, Karolinska Institutet, Stockholm, Sweden
- Second opponent: Professor Maja-Lisa Løchen, UiT - The Arctic University of Norway, Tromsø
- Third member and chair of the evaluation committee: Professor II Arnljot Tveit, University of Oslo
Chair of the Defence
Professor II Thor Edvardsen, University of Oslo
Principal Supervisor
Trygve Sundby Hall, Oslo University Hospital
Summary
One in three is expected to develop atrial fibrillation (AF), a condition related to substantial morbidity and mortality. Although anticoagulation therapy reduces stroke risk, application has been inadequate with geographic variation. Rhythm control strategies can relieve symptoms, but there are conflicting data on their effect on cardiovascular outcomes.
The aim of this thesis was to assess characteristics, treatment, and cardiovascular outcomes of patients with newly diagnosed AF, with focus on anticoagulation therapy in Nordic and Non-Nordic European countries, and early initiated rhythm versus rate control strategies globally.
Observational data were extracted from the Global Anticoagulant Registry in the FIELD-AF (GARFIELD-AF). A total of 52 057 patients were enrolled from 35 countries between March 2010 and August 2016. Patients included were diagnosed with AF within the last 6 weeks and had an additional stroke risk factor.
The use of anticoagulation treatment was higher in Nordic compared to Non-Nordic European patients (78.2% vs 72%), while antiplatelet monotherapy was less often prescribed (10.4% vs 18.2%).
In the global cohort, patients who received an early cardioversion (≤ 48 days post enrolment) had an adjusted hazard ratio within two-year follow-up for all-cause mortality of 0.75 (95% CI 0.67–0.85, p<0.001). Direct current cardioversion was performed twice as often as pharmacological cardioversion.
Half of the non-permanent AF patients were initiated on early rhythm control (including cardioversion, antiarrhythmic drugs, or ablation). Adjusted hazard ratio of rhythm versus rate control for non-haemorrhagic stroke was 0.84 (0.72–0.97, p=0.020) and for all-cause mortality 0.85 (0.79–0.92, p<0.0001).
In conclusion, stroke prevention in AF patients can be improved both in Nordic and non-Nordic regions, and initiation of a rhythm control strategy early after AF diagnosis was associated with lower risk of non-haemorrhagic stroke and all-cause mortality.
Additional information
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