Research Reveals that the Most Frequent Side Effect of Atrial Fibrillation is Heart Failure Rather than Stroke

According to a Danish study published, the lifetime risk of atrial fibrillation—a heart ailment that produces an irregular and frequently abnormally high pulse rate—has climbed from one in four to one in three over the previous 20 years.

Furthermore, among those who have the illness, one in five will have a stroke and two in five are likely to suffer heart failure during the course of their remaining lives, with little to no change in risk observed over the course of the 20-year research.

Therefore, the researchers conclude that preventative interventions for heart failure and stroke are necessary for individuals with atrial fibrillation.

By 2060, there will be 18 million cases of atrial fibrillation in Europe, and by 2050, there will be 16 million cases in the US. Atrial fibrillation is diagnosed in the English National Health Service (NHS) more often than the four most frequent causes of cancer combined. Direct costs associated with atrial fibrillation have reached £2.5 billion.

The risk of stroke has been the main focus of patient management once atrial fibrillation starts; other consequences, like heart failure and heart attack, have not yet been thoroughly investigated.

In order to fill this knowledge vacuum, researchers examined national data for 3.5 million Danish adults who were 45 years of age or older and had no prior history of atrial fibrillation to determine whether or not they developed atrial fibrillation over a 23-year span (2000–22).

All 362,721 people (46% women and 54% men) who received a new diagnosis of atrial fibrillation over this period and had no problems were then monitored until heart failure, stroke, or heart attack was diagnosed.

A number of potentially significant variables were also included, including family income, educational attainment, history of high blood pressure, diabetes, high cholesterol, heart failure, and chronic lung and renal illness.

The lifetime risk of atrial fibrillation increased from 24% in 2000–10 to 31% in 2011–22, according to the statistics. Men and those with a history of diabetes, chronic renal disease, heart failure, heart attacks, and stroke experienced a higher increase.

Heart failure (lifetime risk: 41%) was the most frequent consequence among patients with atrial fibrillation. This was four times higher than the lifetime risk of a heart attack (12%), and double that of any stroke (21%) altogether.

Men were shown to have a significantly reduced lifetime risk of stroke following atrial fibrillation (21% vs. 23%), but women had a slightly higher lifetime risk of heart failure (44% vs. 33%) and heart attack (12% vs. 10%) problems following atrial fibrillation.

The lifetime risks of heart failure following atrial fibrillation showed virtually no improvement over the 23-year study period (43% in 2000–10 vs. 42% in 2011–22), and the lifetime risks of any stroke, ischemic stroke, and heart attack following atrial fibrillation showed only modest (4–5%) decreases, with the latter two being similar for men and women.

Because this is an observational study, it is impossible to draw solid conclusions about what causes what, and the authors themselves admit that it is possible that they overlooked patients who had undetected atrial fibrillation. They further state that results might not apply to other nations or environments because they lacked data on lifestyle or ethnicity-related variables.

But in spite of these limitations, they conclude, “Our novel quantification of the long term downstream consequences of atrial fibrillation highlights the critical need for treatments to further decrease stroke risk as well as for heart failure prevention strategies among patients with atrial fibrillation.”

During this study period, stroke prevention strategies have dominated atrial fibrillation research and guidelines. However, according to UK experts in a linked editorial, there is no evidence to support the idea that these interventions can prevent incident heart failure.

In addition, they state that this strong observational research “provides novel information that challenges research priorities and guideline design, and raises critical questions for the research and clinical communities about how the growing burden of atrial fibrillation can be stopped.” They demand that guidelines and randomized clinical trials be aligned “to better reflect the needs of the real-world population with atrial fibrillation.”