Although the Framingham Heart Study 3 found that AF and AFL were associated with equal outcome of stroke, findings are weakened by the small study population. For example, one study 10 reported a higher incidence of mortality among patients with AF than among those with AFL during a 7-year observation period, and another study 11 reported a lower incidence of stroke among patients with solitary AFL compared with those with AF. 7 Although AF and AFL share many common risk factors for occurrence, 4, 5, 8, 9 differences in clinical outcomes have been reported. 3, 6 Therefore, the pharmacologic management of AFL is usually considered to be the same as for AF, especially for preventing thromboembolic events. 4 Atrial flutter is similar to AF in that its incidence increases with age 4, 5 and it contributes to heart failure, stroke, and all-cause mortality. 3 The incidence of AFL was reported to be 88 per 100 000 people, and the incidence of solitary AFL was reported to be 37 per 100 000 person-years in the general population during the 4-year observational study of the Marshfield Epidemiologic Study Area. 1, 2 The incidence of AFL is approximately one-sixteenth that of AF. The current recommended level of the CHA 2DS 2-VASc score in preventing ischemic stroke in patients with AFL should be reevaluated.Ītrial flutter (AFL) and atrial fibrillation (AF) are often grouped together in terms of risk stratification and in epidemiologic studies. For the AF cohort vs the AFL cohort, the incidences of ischemic stroke and heart failure hospitalization were significantly higher at a CHA 2DS 2-VASc score of 1 or higher, but the incidence of all-cause mortality was significantly higher only at CHA 2DS 2-VASc scores of 1 to 3.Ĭonclusions and Relevance This study found different clinical outcomes between patients with AFL and AF and those without AF and AFL. For the AFL cohort vs the matched control cohort, the incidences of heart failure hospitalization and all-cause mortality were significantly higher across all levels, but the incidence of ischemic stroke was only significantly higher at CHA 2DS 2-VASc scores of 5 to 9. The patients with AF were older, were more predominantly female, and had higher CHA 2DS 2-VASc scores than the patients with AFL and the control participants. Results This study comprised 188 811 patients in the AF cohort (mean age, 73.8 years 104 703 male), 6121 patients in the AFL cohort (mean age, 67.7 years 3735 male), and 24 484 patients in the matched control cohort (mean age, 67.3 years 14 940 male). Main Outcomes and Measures Ischemic stroke, heart failure hospitalization, and all-cause mortality among the AF, AFL, and matched control cohorts were analyzed using Cox proportional hazards regression. Clinical outcomes were compared after stratification by CHA 2DS 2-VASc score (possible score range, 0-9 higher scores indicate greater risk of ischemic stroke). A total of 219 416 age- and sex-matched individuals participated in the study. Follow-up and data analysis ended December 31, 2012. Objective To investigate differences in clinical outcomes among AF, AFL, and matched control cohorts.ĭesign, Setting, and Participants This nationwide cohort study analyzed data from the Taiwan National Health Insurance Research Database from January 1, 2001, through December 31, 2012. Importance Current guidelines support treating atrial fibrillation (AF) and atrial flutter (AFL) as equivalent risk factors for ischemic stroke stratified by CHA 2DS 2-VASc scores, recommending anticoagulation therapy for patients with a CHA 2DS 2-VASc score of 2 or higher, but some studies found differences in clinical outcomes. Shared Decision Making and Communication. Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography.
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