Background: Valvular atrial fibrillation (AF), defined as AF patients with prosthetic or rheumatic mitral valve, increases the risks of thromboembolism. However, outcomes of non-valvular AF patients with valvular heart disease (VHD) were unknown. We investigated characteristics and clinical events in non-valvular AF patients with VHD.
Methods: The Fushimi AF Registry, a community-based prospective survey, was designed to enroll all of the AF patients in Fushimi-ku, Kyoto. Follow-up data including prescription status and echocardiography data were available for 3,223 patients. 87 patients with valvular AF were excluded. We compared between 587 AF patients (18.7%) with VHD and 2,549 (81.3%) without VHD at baseline.
Results: Of 587 patients with VHD, 388 patients (66.1%) had mitral regurgitation, 84 patients (14.3%) had aortic stenosis, 142 patients (24.2%) had aortic regurgitation, and 173 patients (29.5%) had tricuspid regurgitation, respectively. Patients with VHD were more often female (49.7% vs. 37.1%; p<0.01), older (76.9 vs. 73.0 years of age; p<0.01), and more of persistent/permanent AF (65.8% vs. 56.0%; p<0.01). They were more likely to have pre-existing heart failure (HF) (56.7% vs. 23.3%; p<0.01) and chronic kidney disease (CKD) (48.9% vs. 36.1%; p<0.01). They had higher CHA2DS2-VASc score (3.99 vs. 3.26; p<0.01), and were more frequently prescribed oral anticoagulants (OAC) (63.4% vs. 54.3%; p<0.01). During the median follow-up of 1,107 days, stroke or systemic embolism (SE) occurred in 56 patients with VHD (3.25 /100 person-years), and 178 without VHD (2.26 /100 person-years). Multivariable hazard ratio (HR) for VHD, adjusted by component factors of CHA2DS2-VASc score and OAC prescription, was 1.23 (95% confidence interval [CI], 0.89-1.67; p=0.20). Hospitalization for HF occurred in 118 patients with VHD (7.43 /100 person-years), and in 231 without VHD (2.98 /100 person-years), with a multivariable HR adjusted by sex, age, pre-existing HF, hypertension, diabetes, coronary artery disease, CKD, and OAC prescription, of 1.53 (95%CI, 1.21-1.92; p<0.01).
Conclusion: We identified that VHD was not at the significant risk of stroke/SE, but associated with an increased risk of hospitalization for HF in Japanese non-valvular AF patients.