Extract

This editorial refers to ‘In-hospital mortality of patients with atrial arrhythmias: insights from the German-wide Helios hospital network of 161 502 patients and 34 025 arrhythmia-related procedures’, by S. König et al., on page 3947.

Population studies of atrial fibrillation (AF) and randomized clinical trials of anticoagulation for stroke prevention have provided a wealth of information on the outcomes of patients with this arrhythmia. AF is associated with increased risks of stroke, heart failure, and death.1  ,  2 AF as an independent risk for mortality was initially described in the Framingham studies.3 Adjusting for other cardiovascular diseases, AF conferred a 1.5 (men) to 1.9 (women) times increased risk of death in patients aged >55 years. Several subsequent population studies have confirmed this finding. The mechanistic explanation for this association is multifaceted. Lone AF, defined as AF in the absence of structural heart disease or co-morbidities such as diabetes or hypertension, has a survival that is not different from that of age-matched controls.4 However, lone AF is an uncommon entity. Over 70% of patients with AF will have associated morbidities, and a large proportion of the remaining 30% will have unrecognized risk factors such as sleep apnoea and obesity.

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