Older age is a key predictor for major atrial fibrillation (AFib) endpoints among patients with hypertrophic cardiomyopathy (HCM), according to new data published in JACC: Clinical Electrophysiology.
AFib, including atrial flutter, is frequently seen in HCM patients and has been linked to adverse cardiovascular outcomes. To learn more about what may lead to AFib in this patient population, researchers examined data from 2,631 HCM patients who participated in the HCMR trial. Seventy-one percent of patients were male, and the median age was 53.5 years old.
The authors defined "major AFib endpoints" as episodes requiring electrical cardioversion or ablation, episodes leading to hospitalization longer than 24 hours, or episodes that make clinicians accept permanent AFib.
Overall, 96 patients reached a total of 127 major AFib endpoints over the course of the analysis. A total of 24 deaths from a variety of causes were also observed.
In addition, 24 deaths were observed from any cause.
Reviewing the data, the research team found that older age was the biggest predictor of these clinical outcomes. Other factors that can help predict such events include BMI, index left atrial (LA) volume, LA contractile percent, moderate or severe mitral regurgitation (MR), and a prior history of arrhythmia.
Obesity was found to be a stronger risk factor in younger patients, the group added.
Factors that put middle-aged and older adult patients at an increased risk included: increased LA volume, reduced LA contractile percent, and moderate or severe MR.
“This was the first study in HCM to examine predictors of major AFib endpoints rather than all incident AFib,” wrote lead author Christopher M. Kramer, MD, with the University of Virginia Health System, and colleagues. “The principal findings were that age is an important predictor of major AFib endpoints in HCM and that the other predictors, which includes obesity, moderate or severe MR, history of arrhythmia, and CMR-derived increased LAV index and decreased contractile function, were age-dependent.”
Kramer et al. noted: “prospective testing of a risk score based on these parameters may be warranted.”
In addition, “interventions to reduce obesity and MR and improve LA hemodynamics and function might reduce major AFib endpoints, although specific studies of such interventions are needed.”
Read the full study here.