Abstract
Background
Increased mortality is well described in patients with atrial fibrillation (AF), primarily
related to death from cardiovascular causes. One may hypothesize that cardiology care
may be associated with a reduction in cardiovascular deaths in patients with AF, thereby
improving their overall survival. The aim of this study was to assess the association
between cardiologist care and clinical outcomes, including all-cause mortality, in
patients with new-onset AF.
Methods
This was a retrospective population-level, propensity score–matched cohort study of
patients aged 20-80 years with new-onset AF presenting to an emergency department
in Ontario, Canada between 2010 and 2012. Patients who saw a cardiologist within 1
year of the initial diagnosis were matched to patients who did not see a cardiologist.
Linked administrative databases were used for cohort construction and allow for 1-year
follow-up to assess for the clinical end points of death, hospitalization for AF,
stroke syndromes, bleeding, and heart failure.
Results
Cardiologist care was associated with a lower 1-year rate of death (5.3% vs 7.7%;
hazard ratio, 0.68; 95% confidence interval, 0.55-0.84), despite an increased rate
of hospitalizations for AF (17.9% vs 8.2%), stroke syndromes (1.7% vs 0.5%), bleeding
(3.1% vs 2.0%), and heart failure (3.2% vs 1.4%).
Conclusions
Cardiologist care was associated with a reduction in death in patients with new-onset
AF. Further study to obtain a greater understanding of the processes of care associated
with the observed survival improvement is warranted.
Résumé
Introduction
L’augmentation de la mortalité est bien décrite chez les patients atteints de fibrillation
auriculaire (FA), principalement liée au décès d’origine cardiovasculaire. On peut
émettre l’hypothèse que les soins en cardiologie peuvent être associés à une réduction
des décès d’origine cardiovasculaire chez les patients atteints de FA et, par conséquent,
améliorer leur survie globale. L’objectif de la présente étude était d’évaluer l’association
entre les soins des cardiologues et les résultats cliniques, y compris la mortalité
toutes causes confondues chez les patients atteints d’une FA d’apparition récente.
Méthodes
Il s’agissait d’une étude de cohorte populationnelle rétrospective appariée par score
de propension regroupant des patients de 20 à 80 ans atteints d’une FA d’apparition
récente qui s’étaient présentés dans un service des urgences de l’Ontario, au Canada,
entre 2010 et 2012. Nous avons apparié les patients qui avaient vu un cardiologue
durant l’année du diagnostic initial aux patients qui n’avaient pas vu de cardiologue.
Nous avons utilisé des bases de données administratives liées pour former la cohorte
et prévu 1 an de suivi pour évaluer les critères de jugements cliniques de mortalité,
d’hospitalisations en raison de FA, de syndromes d’accident vasculaire cérébral, d’hémorragies
et d’insuffisance cardiaque.
Résultats
Nous avons associé les soins des cardiologues à un taux de mortalité plus faible après
1 an (5,3 % vs 7,7 % ; rapport de risque, 0,68 ; intervalle de confiance à 95 %, 0,55-0,84), en
dépit d’une augmentation du taux d’hospitalisation en raison de FA (17,9 % vs 8,2 %), des syndromes d’accidents vasculaires cérébraux (1,7 % vs 0,5 %), des hémorragies (3,1 % vs 2,0 %) et de l’insuffisance cardiaque (3,2 % vs 1,4 %).
Conclusions
Nous avons associé les soins des cardiologues à une réduction de la mortalité chez
les patients atteints d’une FA d’apparition récente. Des études subséquentes pour
acquérir une meilleure compréhension des processus de soins associés à l’observation
d’une amélioration de la survie sont justifiées.
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Article info
Publication history
Accepted:
October 2,
2017
Received:
August 14,
2017
Footnotes
See editorial by Wilton, pages 1520–1521 of this issue.
See page 1699 for disclosure information.
Identification
Copyright
© 2017 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
