Asymptomatic AFib patients ‘may not receive adequate treatment'

Asymptomatic atrial fibrillation (AFib) patients could be at a heightened risk for cardiac complications, especially if the condition is paroxysmal, a study published in CHEST reports.

AFib is often asymptomatic, lead author Masahiro Esato, MD, PhD, and colleagues wrote, which can lead to a lack of treatment and a subsequent increased risk of acute ischemic stroke or decompensated heart failure. Paroxysmal AFib (PAF) additionally complicates diagnoses, since it’s characterized by intermittent AFib, lasts for less than a week and typically resolves without medical intervention.

“Although asymptomatic AFib is common in daily ‘real-world’ clinical practice, the relationship between patient characteristics, clinical outcomes and symptom presentation has not been consistent across studies and therefore remains controversial,” Esato said in an Elsevier release. “Our study was designed to shed light on this relationship.”

Esato’s team studied nearly 4,000 members of the Fushimi AF Registry in Japan, splitting the pool into a 1,837-patient PAF cohort and a 1,912-patient sustained AFib (SAF) group. Thirty-eight percent of the PAF cohort were asymptomatic compared to the SAF cohort’s 67 percent.

Asymptomatic participants enrolled in the PAF group were more likely to be older, male and record higher rates of congestive heart failure, hypertension, diabetes, previous stroke and vascular disease, according to the study. Age, sex, stroke history and chronic kidney disease were proven to be independent determinants of asymptomatic status in that group, though no such link was found in the SAF group.

Asymptomatic PAF patients were also subject to higher rates of all-cause mortality during the average three years of follow-up, the authors wrote, but symptomatic patients in the same cohort didn’t see an equal risk. SAF patients, regardless of their symptomatic status, recorded a stagnant rate of all-cause mortality risk across the board.

Though the study was observational in nature and needs further backup, Esato and co-authors said the data has indeed shed light on the stark differences between symptomatic and asymptomatic patients, which can lend itself to better diagnosis and treatment of the diseases.

“Our study highlights the differences in the clinical profile and outcomes between asymptomatic and symptomatic patients in both the PAF and SAF cohorts,” they wrote. “The present data also showed that asymptomatic patients with PAF may not receive adequate treatment, and thus better identification and management of such patients with PAF would be needed.”