Atrial fibrillation risk factors: Difference between revisions

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==Overview==
==Overview==
Atrial fibrillation (AF) affects millions of people, and the number increases with increasing age. Men are more likely than women to have the condition.  In the United States, AF is more common among Caucasians than African-Americans or Hispanic Americans.
Numerous [[risk factors]] have been found for [[atrial fibrillation]]. There are some reversible [[risk factors]] such as [[alcohol]] drinking and [[alcohol]] [[withdrawal]], [[caffeine]], [[cocaine]], [[stimulant]] and [[smoking]]. Furthermore [[risk factors]] such as [[hypertension]], [[diabetes]], [[obesity]] and [[sedentary lifestyle]] can be considered as reversible conditions that can increase the chance of [[atrial fibrillation]] development. On the other hand [[risk factors]] such as [[hypertrophic obstructive cardiomyopathy]], [[heart failure]], [[chronic renal failure]] and positive [[familial history]] have been introduced as irreversible [[risk factors]] in [[atrial fibrillation]]. There are also conditions that have been recognized as [[risk factors]] for [[ischemia|ischemic]] [[stroke]] or systemic embolization in [[patients]] with [[atrial fibrillation|non-valvular atrial fibrillation]], such as [[Old age|advanced age]], impaired [[left ventricle|left ventricular]] systolic function, [[hypertension]] and [[diabetes]]. [[male|Male sex]], [[Diuretic|diuretic use]] and [[heart|cardiac]] or [[thoracic surgery]] are also among other known [[risk factors]].
The risk of AF increases with age. This is mostly because the risk for heart disease and other conditions that can cause AF also increases with increasing age.


==Risk Factors==
==Risk Factors==
===Reversible or Modifiable Underlying Conditions Associated with Atrial Fibrillation===
===Reversible or Modifiable Underlying Conditions Associated with Atrial Fibrillation===
*[[Alcohol]] and [[alcohol withdrawal]]
*[[Alcohol]] and [[alcohol withdrawal]]
*Breath spray which contains [[alcohol]] <ref name="pmid2914028">{{cite journal| author=Ridker PM, Gibson CM, Lopez R| title=Atrial fibrillation induced by breath spray. | journal=N Engl J Med | year= 1989 | volume= 320 | issue= 2 | pages= 124 | pmid=2914028 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2914028  }} </ref>
*[[Breath spray]] which contains [[alcohol]] <ref name="pmid2914028">{{cite journal| author=Ridker PM, Gibson CM, Lopez R| title=Atrial fibrillation induced by breath spray. | journal=N Engl J Med | year= 1989 | volume= 320 | issue= 2 | pages= 124 | pmid=2914028 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2914028  }} </ref>
*[[Caffeine]] ([[coffee]] or [[tea]])
*[[Caffeine]] ([[coffee]] or [[tea]])
*[[Cocaine]]
*[[Cocaine]]
*[[Smoking]]<ref name="pmid11156892">{{cite journal| author=Allessie MA, Boyden PA, Camm AJ, Kléber AG, Lab MJ, Legato MJ | display-authors=etal| title=Pathophysiology and prevention of atrial fibrillation. | journal=Circulation | year= 2001 | volume= 103 | issue= 5 | pages= 769-77 | pmid=11156892 | doi=10.1161/01.cir.103.5.769 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11156892  }} </ref><ref name="pmid28450367">{{cite journal| author=Staerk L, Sherer JA, Ko D, Benjamin EJ, Helm RH| title=Atrial Fibrillation: Epidemiology, Pathophysiology, and Clinical Outcomes. | journal=Circ Res | year= 2017 | volume= 120 | issue= 9 | pages= 1501-1517 | pmid=28450367 | doi=10.1161/CIRCRESAHA.117.309732 | pmc=5500874 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28450367  }} </ref>
*[[Coronary artery bypass graft surgery]]
*[[Coronary artery bypass graft surgery]]
*Esophageal surgery
*[[Esophagus|Esophageal]] [[surgery]] <ref name="pmid11156892">{{cite journal| author=Allessie MA, Boyden PA, Camm AJ, Kléber AG, Lab MJ, Legato MJ | display-authors=etal| title=Pathophysiology and prevention of atrial fibrillation. | journal=Circulation | year= 2001 | volume= 103 | issue= 5 | pages= 769-77 | pmid=11156892 | doi=10.1161/01.cir.103.5.769 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11156892  }} </ref>
*[[Hyperthyroidism]]
*[[Hyperthyroidism]]
*[[Hypertension]]<ref name="pmid28450367">{{cite journal| author=Staerk L, Sherer JA, Ko D, Benjamin EJ, Helm RH| title=Atrial Fibrillation: Epidemiology, Pathophysiology, and Clinical Outcomes. | journal=Circ Res | year= 2017 | volume= 120 | issue= 9 | pages= 1501-1517 | pmid=28450367 | doi=10.1161/CIRCRESAHA.117.309732 | pmc=5500874 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28450367  }} </ref>
*[[Diabetes]] <ref name="pmid28450367">{{cite journal| author=Staerk L, Sherer JA, Ko D, Benjamin EJ, Helm RH| title=Atrial Fibrillation: Epidemiology, Pathophysiology, and Clinical Outcomes. | journal=Circ Res | year= 2017 | volume= 120 | issue= 9 | pages= 1501-1517 | pmid=28450367 | doi=10.1161/CIRCRESAHA.117.309732 | pmc=5500874 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28450367  }} </ref>
*[[Obesity]] <ref name="pmid28450367">{{cite journal| author=Staerk L, Sherer JA, Ko D, Benjamin EJ, Helm RH| title=Atrial Fibrillation: Epidemiology, Pathophysiology, and Clinical Outcomes. | journal=Circ Res | year= 2017 | volume= 120 | issue= 9 | pages= 1501-1517 | pmid=28450367 | doi=10.1161/CIRCRESAHA.117.309732 | pmc=5500874 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28450367  }} </ref>
*[[Hypomagnesemia]]<ref name="pmid23172839">{{cite journal| author=May Khan A, Lubitz SA, Sullivan LM, Sun JX, Levy D, Vasan RS et al.| title=Low Serum Magnesium and the Development of Atrial Fibrillation in the Community: The Framingham Heart Study. | journal=Circulation | year= 2012 | volume=  | issue=  | pages=  | pmid=23172839 | doi=10.1161/CIRCULATIONAHA.111.082511 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23172839  }} </ref>
*[[Hypomagnesemia]]<ref name="pmid23172839">{{cite journal| author=May Khan A, Lubitz SA, Sullivan LM, Sun JX, Levy D, Vasan RS et al.| title=Low Serum Magnesium and the Development of Atrial Fibrillation in the Community: The Framingham Heart Study. | journal=Circulation | year= 2012 | volume=  | issue=  | pages=  | pmid=23172839 | doi=10.1161/CIRCULATIONAHA.111.082511 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23172839  }} </ref>
*[[Hypothermia]]
*[[Hypothermia]]
*[[Hypothyroidism]]
*[[Hypothyroidism]]
*[[Hypoxia]]
*[[Hypoxia]]
*[[Pericarditis]] and pericardial disease in general
*[[Pericarditis]] and [[Pericarditis|pericardial disease]] in general
*[[Pheochromocytoma]]
*[[Pheochromocytoma]]
*[[Pulmonary embolism]]
*[[Pulmonary embolism]]
*[[Stimulants]]
*[[Stimulants]]
*[[Sedentary lifestyle]] <ref name="pmid28450367">{{cite journal| author=Staerk L, Sherer JA, Ko D, Benjamin EJ, Helm RH| title=Atrial Fibrillation: Epidemiology, Pathophysiology, and Clinical Outcomes. | journal=Circ Res | year= 2017 | volume= 120 | issue= 9 | pages= 1501-1517 | pmid=28450367 | doi=10.1161/CIRCRESAHA.117.309732 | pmc=5500874 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28450367  }} </ref>
*[[Sleep apnea]] <ref name="pmid28450367">{{cite journal| author=Staerk L, Sherer JA, Ko D, Benjamin EJ, Helm RH| title=Atrial Fibrillation: Epidemiology, Pathophysiology, and Clinical Outcomes. | journal=Circ Res | year= 2017 | volume= 120 | issue= 9 | pages= 1501-1517 | pmid=28450367 | doi=10.1161/CIRCRESAHA.117.309732 | pmc=5500874 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28450367  }} </ref>


===Irreversible Underlying Conditions Associated with Atrial Fibrillation===
===Irreversible Underlying Conditions Associated with Atrial Fibrillation===
*[[Hypertrophic Obstructive Cardiomyopathy]]
*[[Hypertrophic Obstructive Cardiomyopathy]] <ref name="pmid11156892">{{cite journal| author=Allessie MA, Boyden PA, Camm AJ, Kléber AG, Lab MJ, Legato MJ | display-authors=etal| title=Pathophysiology and prevention of atrial fibrillation. | journal=Circulation | year= 2001 | volume= 103 | issue= 5 | pages= 769-77 | pmid=11156892 | doi=10.1161/01.cir.103.5.769 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11156892  }} </ref>
*[[Heart failure]]<ref name="pmid21920917">{{cite journal| author=Chamberlain AM, Redfield MM, Alonso A, Weston SA, Roger VL| title=Atrial fibrillation and mortality in heart failure: a community study. | journal=Circ Heart Fail | year= 2011 | volume= 4 | issue= 6 | pages= 740-6 | pmid=21920917 | doi=10.1161/CIRCHEARTFAILURE.111.962688 | pmc=3222889 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21920917  }} </ref>
*[[Heart failure]]<ref name="pmid21920917">{{cite journal| author=Chamberlain AM, Redfield MM, Alonso A, Weston SA, Roger VL| title=Atrial fibrillation and mortality in heart failure: a community study. | journal=Circ Heart Fail | year= 2011 | volume= 4 | issue= 6 | pages= 740-6 | pmid=21920917 | doi=10.1161/CIRCHEARTFAILURE.111.962688 | pmc=3222889 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21920917  }} </ref>
*[[Short QT syndrome]]
*[[Short QT syndrome]]
*[[Chronic renal failure]]<ref name="pmid22949543">{{cite journal| author=McManus DD, Rienstra M, Benjamin EJ| title=An update on the prognosis of patients with atrial fibrillation. | journal=Circulation | year= 2012 | volume= 126 | issue= 10 | pages= e143-6 | pmid=22949543 | doi=10.1161/CIRCULATIONAHA.112.129759 | pmc=3678907 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22949543  }} </ref>
*[[Chronic renal failure]]<ref name="pmid22949543">{{cite journal| author=McManus DD, Rienstra M, Benjamin EJ| title=An update on the prognosis of patients with atrial fibrillation. | journal=Circulation | year= 2012 | volume= 126 | issue= 10 | pages= e143-6 | pmid=22949543 | doi=10.1161/CIRCULATIONAHA.112.129759 | pmc=3678907 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22949543  }} </ref>
*[[Coronary heart disease|Ischemia heart disease]]<ref name="pmid11156892">{{cite journal| author=Allessie MA, Boyden PA, Camm AJ, Kléber AG, Lab MJ, Legato MJ | display-authors=etal| title=Pathophysiology and prevention of atrial fibrillation. | journal=Circulation | year= 2001 | volume= 103 | issue= 5 | pages= 769-77 | pmid=11156892 | doi=10.1161/01.cir.103.5.769 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11156892  }} </ref>
*Familial history <ref name="pmid20551423">{{cite journal| author=Lubitz SA, Ozcan C, Magnani JW, Kääb S, Benjamin EJ, Ellinor PT| title=Genetics of atrial fibrillation: implications for future research directions and personalized medicine. | journal=Circ Arrhythm Electrophysiol | year= 2010 | volume= 3 | issue= 3 | pages= 291-9 | pmid=20551423 | doi=10.1161/CIRCEP.110.942441 | pmc=3062900 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20551423  }} </ref>


===Risk Stratification===
===Risk Stratification===
Line 67: Line 74:
| [[Heart failure]] or impaired [[left ventricle|left ventricular]] systolic function              ||  <center> 1.4</center>
| [[Heart failure]] or impaired [[left ventricle|left ventricular]] systolic function              ||  <center> 1.4</center>
|-
|-
| [[Coronary artery disease]] (CAD)                                              ||  <center> 1.5</center>
| [[Coronary artery disease]] ([[Coronary artery disease|CAD]])                                              ||  <center> 1.5</center>
|-
|-
| [[Diabetes mellitus]] (DM)                                                    ||  <center> 1.7</center>
| [[Diabetes mellitus]] ([[Diabetes mellitus|DM]])                                                    ||  <center> 1.7</center>
|-
|-
| Previous [[stroke]] or [[Transient Ischemic Attack]] (TIA)                    ||  <center> 2.5</center>
| Previous [[stroke]] or [[Transient Ischemic Attack]] ([[Transient Ischemic Attack|TIA]])                    ||  <center> 2.5</center>
|}
|}


===Other Risk Factors===
===Other Risk Factors===
*[[male|Male sex]] <ref name="pmid11156892">{{cite journal| author=Allessie MA, Boyden PA, Camm AJ, Kléber AG, Lab MJ, Legato MJ | display-authors=etal| title=Pathophysiology and prevention of atrial fibrillation. | journal=Circulation | year= 2001 | volume= 103 | issue= 5 | pages= 769-77 | pmid=11156892 | doi=10.1161/01.cir.103.5.769 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11156892  }} </ref>
*[[male|Male sex]] <ref name="pmid11156892">{{cite journal| author=Allessie MA, Boyden PA, Camm AJ, Kléber AG, Lab MJ, Legato MJ | display-authors=etal| title=Pathophysiology and prevention of atrial fibrillation. | journal=Circulation | year= 2001 | volume= 103 | issue= 5 | pages= 769-77 | pmid=11156892 | doi=10.1161/01.cir.103.5.769 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11156892  }} </ref>
*
*[[Diuretic|Diuretic use]] <ref name="pmid11156892">{{cite journal| author=Allessie MA, Boyden PA, Camm AJ, Kléber AG, Lab MJ, Legato MJ | display-authors=etal| title=Pathophysiology and prevention of atrial fibrillation. | journal=Circulation | year= 2001 | volume= 103 | issue= 5 | pages= 769-77 | pmid=11156892 | doi=10.1161/01.cir.103.5.769 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11156892  }} </ref>
*[[heart|Cardiac]] or [[thoracic surgery]] <ref name="pmid11156892">{{cite journal| author=Allessie MA, Boyden PA, Camm AJ, Kléber AG, Lab MJ, Legato MJ | display-authors=etal| title=Pathophysiology and prevention of atrial fibrillation. | journal=Circulation | year= 2001 | volume= 103 | issue= 5 | pages= 769-77 | pmid=11156892 | doi=10.1161/01.cir.103.5.769 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11156892  }} </ref>


==Reference==
==Reference==

Latest revision as of 04:20, 30 August 2021
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Anahita Deylamsalehi, M.D.[2]

Overview

Numerous risk factors have been found for atrial fibrillation. There are some reversible risk factors such as alcohol drinking and alcohol withdrawal, caffeine, cocaine, stimulant and smoking. Furthermore risk factors such as hypertension, diabetes, obesity and sedentary lifestyle can be considered as reversible conditions that can increase the chance of atrial fibrillation development. On the other hand risk factors such as hypertrophic obstructive cardiomyopathy, heart failure, chronic renal failure and positive familial history have been introduced as irreversible risk factors in atrial fibrillation. There are also conditions that have been recognized as risk factors for ischemic stroke or systemic embolization in patients with non-valvular atrial fibrillation, such as advanced age, impaired left ventricular systolic function, hypertension and diabetes. Male sex, diuretic use and cardiac or thoracic surgery are also among other known risk factors.

Risk Factors

Reversible or Modifiable Underlying Conditions Associated with Atrial Fibrillation

Irreversible Underlying Conditions Associated with Atrial Fibrillation

Risk Stratification

  • Once a patient develops atrial fibrillation, their risk of subsequent events can be assessed using the following scores:
  • The risk of bleeding associated with anticoagulation can be assessed using the following score:

Risk factors for Ischemic Stroke or Systemic Embolization in Patients with Non-valvular Atrial Fibrillation

Risk factors and relative risks are tabulated below: [8][9][2]

Risk Factor Relative Risk
Advanced age (continuous, per decade)
1.4
History of hypertension
1.6
Heart failure or impaired left ventricular systolic function
1.4
Coronary artery disease (CAD)
1.5
Diabetes mellitus (DM)
1.7
Previous stroke or Transient Ischemic Attack (TIA)
2.5

Other Risk Factors

Reference

  1. ↑ Ridker PM, Gibson CM, Lopez R (1989). "Atrial fibrillation induced by breath spray". N Engl J Med. 320 (2): 124. PMID 2914028.
  2. ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 Allessie MA, Boyden PA, Camm AJ, Kléber AG, Lab MJ, Legato MJ; et al. (2001). "Pathophysiology and prevention of atrial fibrillation". Circulation. 103 (5): 769–77. doi:10.1161/01.cir.103.5.769. PMID 11156892.
  3. ↑ 3.0 3.1 3.2 3.3 3.4 3.5 Staerk L, Sherer JA, Ko D, Benjamin EJ, Helm RH (2017). "Atrial Fibrillation: Epidemiology, Pathophysiology, and Clinical Outcomes". Circ Res. 120 (9): 1501–1517. doi:10.1161/CIRCRESAHA.117.309732. PMC 5500874. PMID 28450367.
  4. ↑ May Khan A, Lubitz SA, Sullivan LM, Sun JX, Levy D, Vasan RS; et al. (2012). "Low Serum Magnesium and the Development of Atrial Fibrillation in the Community: The Framingham Heart Study". Circulation. doi:10.1161/CIRCULATIONAHA.111.082511. PMID 23172839.
  5. ↑ Chamberlain AM, Redfield MM, Alonso A, Weston SA, Roger VL (2011). "Atrial fibrillation and mortality in heart failure: a community study". Circ Heart Fail. 4 (6): 740–6. doi:10.1161/CIRCHEARTFAILURE.111.962688. PMC 3222889. PMID 21920917.
  6. ↑ McManus DD, Rienstra M, Benjamin EJ (2012). "An update on the prognosis of patients with atrial fibrillation". Circulation. 126 (10): e143–6. doi:10.1161/CIRCULATIONAHA.112.129759. PMC 3678907. PMID 22949543.
  7. ↑ Lubitz SA, Ozcan C, Magnani JW, Kääb S, Benjamin EJ, Ellinor PT (2010). "Genetics of atrial fibrillation: implications for future research directions and personalized medicine". Circ Arrhythm Electrophysiol. 3 (3): 291–9. doi:10.1161/CIRCEP.110.942441. PMC 3062900. PMID 20551423.
  8. ↑ Estes NA, Halperin JL, Calkins H, Ezekowitz MD, Gitman P, Go AS et al. (2008) ACC/AHA/Physician Consortium 2008 clinical performance measures for adults with nonvalvular atrial fibrillation or atrial flutter: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures and the Physician Consortium for Performance Improvement (Writing Committee to Develop Clinical Performance Measures for Atrial Fibrillation): developed in collaboration with the Heart Rhythm Society. Circulation 117 (8):1101-20. DOI:10.1161/CIRCULATIONAHA.107.187192 PMID: 18283199
  9. ↑ Nieuwlaat R, Prins MH, Le Heuzey JY, Vardas PE, Aliot E, Santini M; et al. (2008). "Prognosis, disease progression, and treatment of atrial fibrillation patients during 1 year: follow-up of the Euro Heart Survey on atrial fibrillation". Eur Heart J. 29 (9): 1181–9. doi:10.1093/eurheartj/ehn139. PMID 18397874.

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